Are there any limitations set for types of patients/ procedures for office-based surgery?
According to the ASA “Guidelines for Ambulatory Surgery and Anesthesia,” “patients who by reason of pre-existing medical or other conditions may be at undue risk for complications should be referred to an appropriate facility for performance of the procedure and administration of anesthesia.” This leaves a very wide margin for interpretation. The anesthesiologist must determine on an individual basis the risk/benefit for each patient. Patients with a history of sleep apnea or obesity/morbid obesity present unique challenges in the office setting. Other con-ditions that may preclude an office-based anesthetic would include brittle diabetes, a history of substance abuse, moderate to severe chronic obstructive pulmonary disease, or risk of aspiration. Each case must be considered on its individual merits.
Over the past several years the procedures performed in offices have increased in complexity and become more invasive in nature. Some surgical procedures that may have required inpatient hospitalization 10 years ago can now safely be performed in an office. However, some proce-dures should still be avoided. These procedures would include those that are associated with significant blood loss, fluid shifts, or hypothermia. Procedures should not exceed 6 hours in duration and should be completed by 3:00 pm to insure adequate postoperative monitoring.