Facelift in Hospital Versus in ASC?

Dear Doberman,

You have asked so many questions that you are running the risk of "paralysis by analysis." At some point you are going to have to pull the trigger and decide what to do, where to do it and with whom!

For a healthy patient, I will estimate that 90+% of plastic surgeons would do this in an ASC. There is no particular medical need to be in a hospital unless it is one that is set up to specifically cater to cosmetic patients for their comfort.

I sincerely hope you can try to make some decisions now with all the good info you have gotten and move forward. Good luck!

You raise valid questions about cosmetic surgery in the hospital setting. While I've been on the staff of Cedars-Sinai hospital in Los Angeles for over 35 years, I have not done a facelift in the hospital since 1982.

Most surgeons responding to questions on Real Self do their facelift surgery in an ASC, although all have hospital privileges. Patients are more comfortable in a private setting where the entire staff is devoted to their care and needs, not surrounding emergencies and critically ill patients.

IF you are otherwise healthy there are few reasons you should have the plastic surgery in a hospital other than the surgeon whom you chose based on his/her excellent results prefers to perform surgery there. However, this may be a very good reason. They may be better able to control your postoperative blood pressure and

You clearly are well acquainted with the process as can be revealed by your knowledge of the terminology and events. The problems that occurred at MEETH can occur anywhere.

In spite of many problems in hospitals, when different organizations have looked at procedures like facelifts done in either hospitals, ASC’s, or fully accredited office OR’s, there is no difference in the safety between any of them. For a full facelift, an overnight stay is also the safest plan, whether this is in a hospital or other overnight facility. If you are concerned with costs, because of competition, many hospitals charge no more than other facilities. I used to do all my surgery at an ASC. Now I do it in a hospital. The hospital is less expensive, and I have seen no problem with safety or patient care. As long as the facility is accredited, where it is performed makes no difference.

While a facelift can be safely performed in either an outpatient surgical setting or a hospital, my preference is in a credentialed outpatient setting. The risks of noscomial (including staph) infections are lower and it is typically less costly. Also, as far as safety is concerned this is very little difference since the safety equipment is virtually and should be essentially the same. As a surgery center surveyor for a large accrediting organization, I would say the outcomes are excellent at the vast majority of centers and is more dependent upon the surgeon than the actual center itself. As far as medication errors, I don't know that there is a whole lot of difference there and whether students are used or not is up to you always and your treating surgeon. I hope this information helps.

The issues you raise are valid ones, in that hospitals are for sick people and ASC's are often designed more specifically for aesthetic surgery patients. However, if you have any medical conditions such as diabetes or heart disease, it may make more sense to do it where you can be monitored afterwards, assuming the risk of having the procedure is acceptable. But outpatient surgery requires that there be someone with you as a caregiver, regardless of your medical status, and so practical considerations may steer you toward hospital surgery. In the end the choice of surgeon is most important so if your doctor prefers to do it in hospital then that is the way to go.

Most facelifts are performed in an ASC, hopefully a highly credentialed outpatient facility. The operating room in a credentialed facility should look very much like a hospital, especially if they have the same accreditation (i.e. Medicare).

There are certainly pluses and minuses of each, anesthesia providers (MD vs. nurse anesthetist), who is doing your surgery (attending or resident), etc. so you should seek answers to those questions before undergoing your procedure.

While it probably doesn't make much difference at the end of the day whether the surgery is performed at a fine hospital or a highly credentialed ASC, the doctor performing the surgery makes all the difference in the world, and should have privileges at both a fine hospital and an ASC so the patient can choose.

I agree with Dr. Rand! If you are not comfortable, don't have surgery.

It is ridiculous to think that hospitals are less safe than private office-based surgery centers. Yes, things happen, but I can assure you that hospitals have much more active and transparent mechanisms from quality assurance (and more at stake) than does a one or two room surgery center based in someone's office.

However, office based surgery centers also go through accreditation (at least in California if they are doing general anesthesia) but the quality assurance committee for an office based surgery center simply lacks the resources of the hospital based surgery centers.

Please let us know how your facelift goes.

I would agree with Dr. Rand. Having seen several questions that you have recently posted, while all very important and meaningful questions, if you are having this much indecision and concern, I would suggest just not doing anything.

As to your current question, facelifts are very safely done in an ambulatory surgery center (ASC) setting all of the time. In my practice, all of my facelifts are done in an ASC without overnight hospitalization.

As to your questions about a hospital:

1) There is a considerable body of evidence to show an increased rate of complications in hospital versus ASC facilities. This is a general statement and may not apply to the particular facility where you are having your procedure. You can always ask the hospital for their infectious complication rate.

2) Medication errors are a risk in hospitals and ASC settings. I would not use this is a concern.

3) Malfunctioning equipment is also a concern in any setting. Though I know of no direct evidence, my feeling would be that hospital would be less likely than an ASC to have malfunctioning equipment. Hospitals are generally accredited by JCAHO. This body is well known as the most stringent of any accrediting board for hospitals and ASC facilities. In addition, most hospitals have on site biomedical technicians to perform repairs. Therefore, if there is a malfunction during surgery, hospitals are in a much better position to deal with the problem than an ASC who generally contracts with an off-site vendor to perform repair and maintenance.

4) Training programs are not at every hospital. In fact, I work at three different hospitals in a suburb of Dallas and none of them have fellows/interns/residents (except for the fellow which works with me). Even at teaching institutions, the interaction of trainees with cosmetic surgery patients is generally limited.

5) Cost: You are correct that hospitals will be more expensive than a surgery center. I have found, though, that this increase in cost is rather minimal in the hospitals I deal with. With the costs I have seen, I believe it more important to choose the physician and not be overly concerned about the added cost of the hospital.

6) Overnight stays: While I do not believe that an overnight stay is warranted after any facial cosmetic surgery procedure, it is not inapprorpriate by any means. In some cases, patients request an overnight stay to have someone help them with aftercare. In my practice, if a patient requests assistance, I arrange either a hospital stay or a private nurse at the patient's home or a local hotel with a suite or adjoining rooms.