The Virginia Society of Plastic Surgeons has been working with the Medical Society of Virginia, MSV, to improve the safety of plastic surgical procedures carried out in an outpatient environment in the State of Virginia. Board certified Plastic Surgeons have standards directed at safety supplied by the American Society of Plastic surgeons as well as from outpatient Operating Room approval agencies such as AAAASF sand AAAHC. No such guidelines exist for non-Plastic surgeon physicians. Instances of grossly exceeding safe guidelines have occurred and will occur in the future. The following guidelines have been supported by the MSV and will be submitted to the Virginia Board of Medicine for their participation in establishing the specifications and subsequently for the Board’s approval. This is an important step as it establishes the need for controls on the activities of Physicians practicing in an outpatient environment.
Suggested Board Amendments
- 18VAC85-20-320 A.1 and 2 should be modified so that administration of over 300mg of lidocaine (or equivalent doses of other local anesthetics) will be subject to the requirements for office-based anesthesia.
- 18VAC85-20-340 should be reviewed for consideration of adding evidence-based guidelines or limits regarding the appropriate dosage of lidocaine in an office-based setting with respect to liposuction. In addition, the Board should consider the inclusion of evidence-based limits on the amount of supernatant fat to be removed during liposuction, both when done as a single procedure and as part of a combined procedure.
- 18VAC85-20-340A.2 should be modified with the additional requirement that the maximum planned duration of all surgical procedures combined must not exceed eight hours.
- 18VAC85-20-370.B should be modified so that “reasonable proximity” is defined as within 30 minute transport time.
- Surgical consent forms for patients who undergo surgery covered by office-based anesthesia regulations (18VAC85-20-310, etc.) should be required to have one of two statements:
- The physician performing the surgery is certified by [list a board or boards recognized by the ABMS]; or
- The physician performing the surgery is not board certified.
In addition, the surgical consent for office-based surgery should contain the wording: The physician and this office comply with the Virginia regulations for office-based anesthesia.