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

Surgical Procedure and Patient Selection

Improvements in surgical technique and equipment have made it possible for surgical procedures that were previously solely performed in the hospital setting to migrate to the ambulatory setting. These include total joint replacement, spine surgery, bariatric surgery, and hysterectomy, to enumerate just a few. Procedure-related factors that may influence perioperative outcomes include invasiveness of the surgical procedure, duration of surgery, potential blood loss and need for blood transfusion (intraoperative and postoperative), ability to control postdischarge pain with oral analgesics and/or local/regional techniques, and need for specialized postoperative care including postoperative parenteral therapy. The limit on duration of surgery remains controversial due to lack of good evidence suggesting that duration of surgery influences rates of transfer, admission, or acute care visits after ambulatory surgery. ASCs are well advised to develop procedure-specific enhanced recovery pathways[15] and patient selection criteria.[16–20]

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