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HomeAnesthesia & Analgesiaindex/list_12253_1Patient Selection for Adult Ambulatory Surgery

Patient Selection for Adult Ambulatory Surgery

Abstract and Introduction

Abstract

With migration of medically complex patients undergoing more extensive surgical procedures to the ambulatory setting, selecting the appropriate patient is vital. Patient selection can impact patient safety, efficiency, and reportable outcomes at ambulatory surgery centers (ASCs). Identifying suitability for ambulatory surgery is a dynamic process that depends on a complex interplay between the surgical procedure, patient characteristics, and the expected anesthetic technique (eg, sedation/analgesia, local/regional anesthesia, or general anesthesia). In addition, the type of ambulatory setting (ie, short-stay facilities, hospital-based ambulatory center, freestanding ambulatory center, and office-based surgery) and social factors, such as availability of a responsible individual to take care of the patient at home, can also influence patient selection. The purpose of this review is to present current best evidence that would provide guidance to the ambulatory anesthesiologist in making an informed decision regarding patient selection for surgical procedures in freestanding ambulatory facilities.

Introduction

Driven by improvements in surgical and anesthetic techniques as well as modifications in postoperative care and health care plan payment patterns (eg, the addition of some procedures to Centers for Medicare & Medicaid Services [CMS] outpatient list), the growth in ambulatory surgery is likely to continue exponentially.[1] Procedures and patients previously deemed unsuitable for the outpatient setting are now increasingly being scheduled for ambulatory surgery.[2] It is therefore incumbent upon the anesthesiologists who practice at these locations to have clearly defined patient selection criteria allowing for safe and efficient care of medically complex patients undergoing extensive surgical procedures with the expectation of discharge to home on the day of surgery.

The process of determining suitability of a patient for surgery as an outpatient is dynamic, involving the complex interplay of several factors such as surgical procedure, patient characteristics, and the expected anesthetic technique (eg, sedation/analgesia, local/regional anesthesia, or general anesthesia). In addition, the type of ambulatory setting (ie, short-stay [23-hour stay] facilities, hospital-based ambulatory center, freestanding ambulatory surgery center [ASC], and office-based surgery) and social factors, such as availability of a responsible individual to take care of the patient at home, can also influence patient selection.

This review will examine existing evidence and provide guidance to the ambulatory anesthesiologist in making an informed decision regarding patient selection for adults undergoing surgical procedures in freestanding ASCs. The review will discuss patient comorbidities that are suitable for ASCs, those that may be suitable but the evidence is equivocal or scarce, and those that are unsuitable based on good evidence. Patient selection for other ambulatory settings is not addressed.

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