UNANTICIPATED HOSPITAL ADMISSION FOLLOWING AMBULATORY SURGERY
Various complications can occur that necessitate emergent transfer to a nearby hospital. Some surgi-cal complications cannot be repaired in the ambu-latory operating suite. Inadequately controlled pain and postoperative nausea and vomiting are the two most frequent causes of unplanned hospital admis-sion from ASCs, with other causes less frequent. Accreditation agencies mandate that office based operating rooms have emergency equipment, drugs, and protocols for patient transfers. In addition to advanced cardiac life support medications, dan-trolene and intravenous lipid emulsion should be available to treat malignant hyperthermia and local anesthetic-induced cardiotoxicity. Additionally, surgeons operating in an office-based practice must have admitting privileges at a nearby hospital or arrangements with an accepting physician to pro-vide for patient transfer, if necessary in addition to a hospital transfer protocol in place. The American Association for Accreditation of Ambulatory Surgery Facilities reviewed 1,141,418 outpatient procedures from 2001 to 2006 in the facilities it accredits and noted 23 deaths. Pulmonary embo-lism following abdominoplasty was the leading cause of death in an office-based surgery facility (Figures 44–3 and 44–4).