A recent article in MedPage Today discussed concerns with the increasing use of anesthesia outside of the operating room. In general, non-OR anesthesia poses greater threats to patient safety than anesthesia in the OR. Examples of the former are interventional cardiology suites or cardiac catheterization labs, interventional radiology suites, or gastroenterology suites where endoscopies and colonoscopies are performed. The proliferation of anesthesia outside the operating room has also focused attention on safety issues.

The concerns for patient safety includes the lack of access to tools available in most operating rooms and the long distance between procedure suites and an OR. If something goes wrong it may take too much time to seek remedial measures or help or to transfer the patient to an OR.  The article, written from the viewpoint of anesthesiologist, also points out that non-OR work is more stressful for the anesthesiologists themselves because of the lack of OR standards of equipment and monitoring, as well as fewer OR personnel to assist if problems arise.

The issues have become more pronounced in the last decade because of a rapidly aging population with more complex comorbidities, and the push to save money by reducing hospital admissions and stays. Surgeons are often advocating for more complex procedures to be done in a surgical center facility rather than a hospital, since the group owning the surgical center can bill for the “facility fees” that would ordinarily go to the hospital rather than the physicians who own and operate the outside facility.  

A series of studies showed higher rates of complications and death for non-OR cases versus those in OR’s. Malpractice claims often involve respiratory issues, including inadequate oxygenation and ventilation. The Anesthesia Patient Safety Foundation now has a task force focusing on non-OR anesthesia, and recently held a consensus conference on non-OR anesthesia issues.