Monitored Anesthesia Care vs. General Anesthesia: A Comparison of 100 Aesthetic Surgeries Performed in an Office-Based Surgical Center

Introduction: The demand for and growth of elective aesthetic procedures have exploded over the past decade. This growth in an era of cost containment has led many physicians to seek a more judicious use of medical resources. Outpatient and office-based surgical centers have risen dramatically throughout the country, in part as a means to achieve such a goal. However, there has been significant debate over the most appropriate, cost-effective, and safe anesthetic techniques for such procedures. The objective of this study was to provide supporting evidence for the safety and efficacy of office-based surgical procedures as well as to evaluate and compare various anesthetic techniques in an era of cost containment. Materials and Methods: We retrospectively analyzed data from 100 consecutive aesthetic surgical cases performed by 2 surgeons who utilized markedly different anesthetic techniques, namely monitored anesthesia care or general anesthesia, in an office-based surgical center. Retrospective data included patient demographics, medical history, type of procedure, vital signs, duration of procedure, duration of recovery, medication dosages, incidence of intraoperative and immediate postoperative complications, and incidence of immediate postoperative nausea, vomiting, and pain. In addition, an operating cost analysis of both anesthetic techniques was performed. Results: There were no deaths or major complications in either group of patients. The average recovery time for the monitored anesthesia care group was 1.0 hour as compared to 1.8 hours in the general anesthesia group. There was a slightly higher incidence of immediate postoperative nausea and/or vomiting as well as immediate postoperative discomfort in the general anesthesia group. In addition, at our facility it was much more cost-effective to provide monitored anesthesia care, at $210.03 per patient as compared to $527.68 per patient undergoing a general anesthetic. Discussion: It is reasonable to conclude from our retrospective data that both monitored anesthesia care and general anesthesia are relatively safe methods for providing anesthesia for elective aesthetic procedures. From a cost perspective, it is clear that monitored anesthesia care offers a more cost-effective means for providing anesthesia; however, the decision to utilize one technique versus the other should be based upon surgeon comfort level, the type of procedure performed, and the patient's desires, if reasonable.