Ambulatory surgery adult patient selection criteria — a survey of Canadian anesthesiologists

Abstract

P Pu ur rp po os se e: : An increasing number of patients with complex medical problems are now considered suitable for ambulatory surgery. The purpose of this study was to identify the current clinical practice of ambulatory surgical patient selection. M Me et th ho od ds s: :A standardized questionnaire specifying 30 clinical conditions was sent to all practicing anesthesiologists who are members of the Canadian Anesthesiologists' Society. Recipients were asked to indicate if they would provide ambulatory anesthesia (yes/no answers) for an adult patient with each of those isolated conditions. A 75% agreement was considered a majority opinion.R Re es su ul lt ts s: : One thousand three hundred thirty-seven questionnaires were sent and 774 replies were received (57.8%). Over 75% of anesthesiologists were willing to include in their selection criteria American Society of Anesthesiologists' (ASA) physical status III, patients with low-grade angina pectoris (AP) and congestive heart failure (CHF), prior myocardial infarction, asymptomatic valvular disease, sleep apnea without use of narcotics, morbid obesity (MO) without co-morbidities, insulin dependent diabetes mellitus and malignant hyperthermia (MH) susceptible patients. Over 75% of responders found ASA IV patients, high grade AP and CHF, sleep apnea with postoperative narcotics, MO with co-morbidities and no patient escort to be unsuitable for ambulatory anesthesia.C Co on nc cl lu us si io on n: : Our survey demonstrated that medical conditions with extreme grades of severity (mild or severe) are associated with majority opinion to proceed or not to proceed with ambulatory surgery. Issues with over 75% agreement reflect the common practice. Similar surveys may form a part of patient selection guidelines development in the future. Objectif

Drug shortages in Canadian anesthesia: a national survey

“…[22][23][24] Considering the size of the CAS data set of active members and post-residency physicians (n = 1,932) and an expected 60% rate of response, we estimated the final sample size to be 1,159 respondents. This sample size would yield a maximum 95% confidence interval (CI) half-width of 3%.…”

Frequency and implications of ambulatory surgery without a patient escort

“…13 In this study, 19 patients were known not to have an escort, but surgeries were still performed. The results of this study show that these patients had a higher percentage of ophthalmic surgery and monitored anesthesia care vs the group of patients with "no show escort".…”

Day Care Laproscopic Cholecystectomy – A Prospective Study

“…After any surgery rapid recuperation of patient"s autonomy, shortened hospital stay, decreased morbidity and costs are directly related to the post operative pain management. Post operative pain is unpredictable, which explains the need for adequate prevention of pain before the patient wakes up from anesthesia [27] . Thus pain relief and patient comfort during the early post operative period becomes increasingly important, as the need for analgesics may delay discharge.…”