PA surgery centers given lap case restrictions

The Harrisburg-based Pennsylvania Department of Health has announced a move that has gotten the attention of ambulatory surgery centers (ASCs) nationwide: Surgery centers in that state no longer can perform some laparoscopic procedures, such as laparoscopic cholecystectomy.

The Alexandria, VA-based Federated Ambulatory Surgery Association (FASA), estimates as many as 44,000 laparoscopic cholecystectomies may have been performed in ASCs in 2003. The agency says about 99% were performed free of complications.

This step by the Pennsylvania department is extremely unusual, says Kathy Bryant, FASA’s executive vice president.

Laparoscopic cholecystectomies are performed throughout the country in ASCs, she points out.

"No quality data suggests that they should not be performed in ASCs," Bryant continues. "The department admitted that it was unaware of any safety problems, nor had it received any complaints."

The notice from the department states: "Laparoscopic procedures are often accompanied by a decrease in pain and a shortening of the recovery period, but the risk of injury to abdominal and other internal organs and structures is not lessened. In fact, there are some reports that the risk of injury may be increased. (Jacobson PD. Medical Liability and the Culture of Technology. Harrisburg, PA: PEW Project on Medical Liability; 2004.) These types of procedures are to be performed within the hospital setting. There are some laparoscopic procedures, such as some hernia repairs, that do not penetrate the peritoneal membrane and therefore are permitted in [ambulatory surgical facilities]."

The department emphasized facilities will be cited and fined for not complying with the notice.

The Pennsylvania decision is a particular concern to FASA officials because it isn’t clear what procedures are covered. The ban could cover procedures including appendectomies and tubal ligation, FASA reports.

The Pennsylvania department says that "most invasions of abdominal or thoracic cavities are major invasions" and thus violate the ASC regulations, but it provided no explanation for how it determined that some laparoscopic surgeries are major procedures. It also failed to explain the criteria and what procedure can and cannot be performed in ASCs.

"The state acknowledges some laparoscopic procedures are, in its view major, and some are not," Bryant says. "Because it has rejected the usual medical distinction between the two, it is incumbent on the department to identify for ASCs what procedures they are now prohibited from doing."

Same-Day Surgery previously reported that managers at a surgery center asked the Pennsylvania Department of Health if they could perform laparoscopic cholecystectomies.

Upon review, the department decided that it was too invasive to be performed at an ambulatory surgery center. The department has cited surgical facilities for performing laparoscopic cholecystectomies.