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What makes a safe environment for office based procedures? - Richard W. Westreich MD. FACS What makes a safe environment for office based procedures? - Richard W. Westreich MD. FACS What makes a safe environment for office based procedures? - Richard W. Westreich MD. FACS


With the recent events surrounding Joan Rivers, many prospective patients are probably wondering about the safety of having procedures in an office-based facility. While no specifics are known about the details of Mrs. Rivers’ medical care, it is important to ask the question; would the outcome have been different if this was done in a hospital?

In terms of patient safety, the following details are critically important:

  • Is the facility certified by an accrediting agency, such as the Joint Commission (JCAHO) or the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF )
    • Certification by either of these entities ensures that the facility has met certain safety standards, which are essentially the same as for hospital operating rooms. These facilities are re-assessed every 3 years in a continuing manner.
  • Having a board-certified anesthesiologist providing anesthesia
  • Making sure that the patient has had an appropriate health assessment and that the patient is safe to undergo anesthesia
  • Making sure that the procedure that is done is appropriate for a non-hospital setting.

Facility Safety Standards

If these standards are met, then there should basically be no difference in safety between the office or hospital-based surgery. Obviously, in an office, the biggest missing ingredient is the presence of other unique health care providers to offer consultations or assistance in the event of an emergency. However, the downsides of being in the hospital are the higher risk of hospital-acquired infections (superbugs), higher costs for patients, less control over operating room personnel, and more wait time/red tape.

From the patient’s perspective, if you have significant cardiac or pulmonary medical issues, a hospital setting can be more appropriate. Additionally, if the surgery is very lengthy (say more than 6 hours), then your overall risk may be higher (in any operating room setting) and you should consider that fact when making your decision about where to have surgery. Finally, if you have had surgery before and had a difficult or lengthy recovery period, a hospital setting may be beneficial, as an overnight stay is always available to those who need it.

Our Facility

Dr. Westreich operates in both hospital and office-based settings. He only uses certified facilities and board-certified anesthesiologists whom he trusts. All patients having surgery in the hospital or office must have a health clearance prior to their procedure. In this way, we ensure that everything possible is being done to avoid problems and give our patients the safest experience possible.

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