Which
patients are considered acceptable candidates for ambulatory surgery?
For patients to be considered acceptable
candidates for ambulatory surgery, generally they should have a relatively
stable medical condition. However, many centers now routinely accept American
Society of Anesthesiologists (ASA) physical status III and IV patients for
selected, relatively noninvasive surgical procedures or diagnostic studies.
Generally, less invasive surgery is performed on patients who are less healthy,
while more invasive surgery is performed only on ASA physical status I or II
patients. Patients with cardiovascular disease have an increased risk of
perioperative complications. Those with severe physical or mental handicaps are
often excluded from consideration as candidates for ambulatory surgery. The
ability to comprehend and comply with postoperative instructions is mandatory
to the success of ambulatory surgery.
Ambulatory surgery is well suited for the
pediatric patient population. Generally, ambulatory surgical proce-dures
commonly performed on children are shorter in duration, less extensive, and
less invasive than the majority of procedures performed on adults. Additional
benefits to the pediatric group include less disruption of the child’s normal
feeding schedule and decreased separation time from parents. Exposure to the
unfamiliar and frightening hospital milieu can be reduced to the bare minimum.
Additionally, because recovery times are short for proce-dures such as
myringotomy and tubes, circumcision, and inguinal herniorrhaphy, early
discharge from the facility is feasible.
Preoperative communication and collaboration
between anesthesiologists and their surgical colleagues are essential in the
case of the questionable or problem patient. The sur-geon who is to perform the
procedure, the patient, and the family must be agreeable to the concept of
ambulatory sur-gery. However, reimbursement schedules created by insur-ance
carriers will often convince the occasional skeptic, because costs associated
with hospitalization for proce-dures that can be readily performed on an
ambulatory basis will usually not be covered. Overwhelming and incontrovertible
evidence of medical necessity for inpatient care must be presented to obtain
authorization for post-operative hospitalization.
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