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Patient selection in ambulatory surgery

Lermitte, Jeremy; Chung, Frances

Current Opinion in Anaesthesiology: December 2005 - Volume 18 - Issue 6 - p 598–602
Ambulatory anesthesia

Purpose of review: To evaluate the evidence regarding decisions made in the perioperative management of patients undergoing ambulatory surgery for the following: the elderly, hyper-reactive airways disease, coronary artery disease, diabetes, obesity, obstructive sleep apnea, the ex-premature infant and the child with an upper respiratory infection.

Recent findings: Major morbidity and mortality following ambulatory surgery is exceedingly low. Minor adverse cardiac events during the intraoperative period are associated with hypertension and the elderly. Minor adverse respiratory events during the intraoperative period are associated with obesity. Respiratory events during the postoperative period are associated with obesity, smoking and asthma. Prolonged stays following ambulatory surgery are predominantly caused by surgical factors or minor symptoms such as pain or nausea. Surgical factors are also the main causes of unplanned admissions. Age greater than 85, significant co-morbidity and multiple admissions to hospital in the 6 months preceding ambulatory surgery, however, are associated with higher readmission rates.

Summary: Evidence indicates that ambulatory anesthesia is currently very safe. Ambulatory surgery, however, is being offered to a population with increasing co-morbidity. As the population undergoing ambulatory surgery changes over time, the evidence regarding patient outcomes will need re-examination.

Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada

Correspondence to Frances Chung FRCPC, Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, McC 2-405, 399 Bathurst St, Toronto, Ontario, Canada M5T 2S8 Tel: +1 416 603 5118; fax: +1 416 603 6494; e-mail: frances.chung@uhn.on.ca

© 2005 Lippincott Williams & Wilkins, Inc.