Office-Based Deep Sedation for Pediatric Ophthalmologic Procedures Using a Sedation Service Model

Aims. (1) To assess the efficacy and safety of pediatric office-based sedation for ophthalmologic procedures using a pediatric sedation service model. (2) To assess the reduction in hospital charges of this model of care delivery compared to the operating room (OR) setting for similar procedures. Background. Sedation is used to facilitate pediatric procedures and to immobilize patients for imaging and examination. We believe that the pediatric sedation service model can be used to facilitate office-based deep sedation for brief ophthalmologic procedures and examinations. Methods. After IRB approval, all children who underwent office-based ophthalmologic procedures at our institution between January 1, 2000 and July 31, 2008 were identified using the sedation service database and the electronic health record. A comparison of hospital charges between similar procedures in the operating room was performed. Results. A total of 855 procedures were reviewed. Procedure completion rate was 100% (C.I. 99.62–100). There were no serious complications or unanticipated admissions. Our analysis showed a significant reduction in hospital charges (average of $1287 per patient) as a result of absent OR and recovery unit charges. Conclusions. Pediatric ophthalmologic minor procedures can be performed using a sedation service model with significant reductions in hospital charges. 1. Introduction Pediatric patients frequently undergo brief ophthalmologic examinations or procedures for the management of such conditions as congenital glaucoma, cataracts, and obstructed nasolacrimal ducts. Frequently, these children are unable to cooperate as a result of their young age or the uncomfortable nature of the procedure [1]. These cases have traditionally been carried out in the operating room (OR) under general anesthesia. Anesthesia in the OR setting incurs extra hospital charges and some degree of inconvenience (e.g., scheduling, recovery time) for the surgeon, patient, and the patient’s family. Thus, an alternative model for providing sedation or anesthesia in a location outside of the OR (a sedation service model) may be advantageous [2]. The sedation service model has the following benefits: (1) procedure seems less “invasive” to the parents and patients, (2) process is more convenient for surgeons as it can be performed as part of an outpatient clinic session, (3) the office location avoids unnecessary utilization of valuable operating room resources and block time, and (4) may result in fiscal benefits to the healthcare system. We believe that the pediatric sedation service