Rationale for office-based foot surgery.

It is clear from this study that the majority of foot surgical cases being done in the United States may be performed in an office-based surgical setting when individual case considerations are made on a case-by-case basis. This entire study reflects the importance of physician preference relative to selecting a surgical environment for management of disorders and surgery of the foot. In some areas, a strong consensus of opinion existed concerning one surgical location or the other, but the overwhelming majority of responses indicated a case-by-case evaluation prior to physician selection of the surgical environment. The Delphi study was well validated by the survey of Alabama podiatrists in this regard. Traditionally, within the United States, the physician has acted as an agent to the patient and as an allocator of health care resources. Perhaps current concepts regarding patient hospitalization for certain surgical procedures would change if the physician were motivated (either intellectually or financially) toward office-based surgery on a individual case basis. Perhaps, in selected elective surgical procedures, patients could be sufficiently informed so that they could voice an opinion or preference relative to selection of the surgical environment. Additional research in this area is necessary. Expanded insight into established patterns of patient hospitalization practices and general anesthesia usage on these hospitalized patients may also be in order. Realizing full well the role of independent physician judgment in these matters, it may be that selection of general anesthesia and hospitalization for some elective surgery procedures reflects the physician's training rather than his appreciation of alternate routes for rendering reasonable and responsible care.(ABSTRACT TRUNCATED AT 250 WORDS)