Patient Selection for Adult Ambulatory Surgery

A Narrative Review

Niraja Rajan, MD; Eric B. Rosero, MD, MSc; Girish P. Joshi, MBBS, MD, FFARCSI

Disclosures

Anesth Analg. 2021;133(6):1415-1430. 

In This Article

Perioperative Outcomes and Patient Selection

Large database studies have found low rates of significant morbidity and mortality after ambulatory surgery.[3–10] The outcome measures of consequence with regard to clinical decision-making in the ambulatory setting include unplanned hospital transfers as well as acute care visits and hospital readmission after discharge from the ambulatory facility. These outcomes may indicate a breach in patient safety and increase health care costs. It is not surprising that the CMS considers all-cause transfer/admission and 7-day risk standardized hospital visit rates as quality measures for payments to ambulatory facilities.[11]

The literature related to these outcome measures that could guide optimal patient selection for ambulatory surgery is sparse and of limited quality due to the retrospective nature of the studies and relatively small effect sizes due to low prevalence of the outcomes of interest. Additionally, analyses of available data provide evidence of association and not causation when detecting risk factors. More importantly, the older retrospective analyses may not always be relevant in the current rapidly changing surgical practice environment. Nevertheless, these data combined with extensive clinical experience can be used to guide decision-making and improve patient safety.

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