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.