In-office surgeries and procedures are typically safer than the operating room procedures when talking about skin surgery and reconstruction.
Dermatologic surgeons have years of experience in office-based surgery and have been at the forefront of these types of procedures. In my practice, I perform a variety of procedures, such as skin cancer removal with Mohs and excisions, reconstructive surgery after skin cancer with skin flaps or skin grafts, benign mole, cyst or cyst removals, and excisional biopsies. I also perform cosmetic procedures like mini facelifts, small volume liposuction and laser skin resurfacing.
There are many benefits to office-based procedures, but sometimes patients may not understand what the benefits entail.
Lower risks, less expensive
Compared to procedures in the operating room, office-based surgeries do not have the same risks associated with anesthesia. Patients are often pleasantly surprised at just how comfortable they can be with local anesthesia; and a typical patient can even drive himself/herself home immediately after the procedure without any nausea or drowsiness.
While all surgery carries a risk for infection, office-based procedures are also typically done outside of a hospital setting, so the risk of wound infections with hospital-acquired superbugs is thought to be lower.
In addition to the safety benefits of office-based surgery, we are living in a time when patients are asked to absorb more and more of their healthcare costs. Because office-based surgery does not often have facility or hospital fees, and does not have separate anesthesia fees or fees based on time spent occupying an operating room, it is often considerably less expensive to the patient, the insurer, and the healthcare system. One case of many that comes to mind is a report from Duke University where a similar reconstruction cost greater than 40 times more to do in the operating room, and had a less optimal result when compared to the reconstruction done under local anesthesia in the office.
Here are some additional benefits of office-based surgery:
- No pre-op testing. For routine cases, generally no pre-operative workup or clearance is needed.
- No stopping blood thinners. Most dermatologists think bleeding complications from skin surgery are easier to deal with than a heart attack or stroke. Patients without a history of heart attack or stroke may stop elective blood thinners that were not recommended by their physician.
- No fasting. Patients can eat, drink and take their regularly scheduled medication.
- No driver generally needed. If a patient is exceptionally nervous or has blood pressure too high to continue, an optional relaxation medicine may be used.
Mohs micrographic surgery in particular is also typically performed in an office setting and has some very unique advantages to traditional excision.
- Highest cure rate. It has the highest cure rate available compared to any other treatment for non-melanoma skin cancer (basal cell carcinoma, squamous cell carcinoma) – more than a 95 percent cure rate for primary skin cancers in healthy patients.
- Tissue sparing. Mohs preserves as much normal tissue as possible for better functional and cosmetic results.
- 100 percent margin evaluation. Mohs looks at all (100 percent) of the deep and outside edges to verify the skin cancer is all out. In comparison, <1 percent of the deep and outside is evaluated for excisions in OR checked with traditional pathology or frozen section. Yes, this is a staggering difference and is why Mohs offers the highest cure rate available.
- Smallest surgical wounds. Usually a less than standard margin is necessary.
- Cosmetically superior with the smallest repairs/scars. Smaller repairs have less risk of complications and tissue death from flap or graft failure.
- Same day results/cure. No waiting for days to weeks to see if margins were positive.
- Mohs is a bundled service. It includes the cost of anesthesia, some pre-operative medication, tissue removal, tissue mapping, tissue processing, and pathology interpretation.
- Same day reconstruction. Patients are usually reconstructed same day. Fellowship-trained Mohs surgeons typically have more skin cancer reconstruction experience than any other specialists. For very large cases, multi-disciplinary approach may be taken.
As you can see, office-based procedures offer many benefits. If you have questions about office-based skin procedures, talk with your doctor.
Matthew Molenda, MD, FAAD, is a ProMedica Physician specializing in dermatology and dermatologic surgery.