Evidence-Based Patient Safety Advisory: Patient Selection and Procedures in Ambulatory Surgery

Abstract

Despite the many benefits of ambulatory surgery, there remain inherent risks associated with any surgical care environment that have the potential to jeopardize patient safety. This practice advisory provides an overview of the preoperative steps that should be completed to ensure appropriate patient selection for ambulatory surgery settings. In conjunction, this advisory identifies several physiologic stresses commonly associated with surgical procedures, in addition to potential postoperative recovery problems, and provides recommendations for how best to minimize these complications.

Assessing patient safety in Canadian ambulatory surgery facilities: A national survey

“…Of the more than 40,000 procedures performed in 2010, key complication rates (ie, reoperations in hospital, transfer to hospital on the day of surgery, admission to hospital on the day of surgery and mortality within 30 days of surgery) were exceedingly low. This attests to the importance of having procedures performed by appropriately qualified physicians and other health care professionals in accredited health care facilities (8)(9)(10)(11)(12)(13)(14). These findings are similar to studies examining patient safety in ambulatory surgery facilities in the United States (2-7).…”

Larger Infiltration/Aspiration Volumes, Plasma/ Subcutaneous Fluid Lidocaine Levels and Quantitative Abdominal Tissue Accommodation After Water-Assisted Liposuction (WAL): Comparative Safety and Efficacy to Traditional Liposuction (TL)

“…Since 1986, advocates preferred either a superwet 9,15-17,28-31 or a tumescent technique 2-8,10, , each of which have established proven safety and efficacy profiles using similar anesthetic solutions, but with significantly differing ratios of infiltration volume to total aspiration volumes. Each technique appears to be safe when strict clinical criteria [11][12][13][14] …”

“…In studies [21][22][23][24][25][26][27]55 associated with high dosages, peak serum levels below toxic levels of 5µg/ml were measured about 10-12 hours after infiltration. In the second part of this study, the lidocaine dosages used in the two patients were calculated at 12.5mg/kg and 29.5mg/kg, exceeding the recommended the safe limit of lidocaine dosage of 7mg/kg with epinephrine in normal healthy adults 31,40 , but below the estimated maximal safe dosage of 35mg/kg, as recommended in the Klein tumescent technique 12 . The low plasma peak levels between 0.80-0.95µg/ml at 9 hours and the elevated subcutaneous fluid levels from lipoaspirates at 1-1 ½ hours (95-130µg/ml) and after 6-8 hours (66-95µg/ml) from the start of lidocaine infiltration were consistent and similar with those observed in previous cited publications.…”

Textbook of Plastic and Reconstructive Surgery

“…The abdomen, thorax and retroperitoneum are all potentially affected areas, with perforations more commonly occurring through previous scars or hernias (Haeck et al, 2009). The surgeon must always be aware of the location of the tip of the cannula.…”