Key result
The migration of increasingly complex surgical procedures and patients to ambulatory and office-based settings requires careful patient selection and safety protocols to maintain patient safety.
Why the study?
With more medically complex patients and procedures shifting to outpatient settings amid a lack of standardized state regulations, anesthesiologists need an understanding of safety concerns regarding patient, procedure, and location selection.
The exponential growth of ambulatory and office-based surgeries for increasingly complex patients requires anesthesiologists to focus on proper patient selection, procedure appropriateness, and surgical location to maintain safety.
Answers are grounded in this paper and cite their sources.
Highlights safety concerns with complex ambulatory cases; leaves open optimal risk stratification pending prospective outcomes research.
In the last quarter of a century, the backdrop of appropriate ambulatory and office-based surgeries has changed dramatically. Procedures that were traditionally done in hospitals or patients being admitted after surgery are migrating to the outpatient setting and being discharged on the same day, respectively, at a remarkable rate. In the face of this exponential growth, anesthesiologists are constantly being challenged to maintain patient safety by understanding the appropriate patient selection, procedure, and surgical location. Recently published literature supports the trend of higher, more medically complex patients, and more complicated procedures shifting towards the outpatient arena. Several reasons that may account for this include cost incentives, advancement in anesthesia techniques, enhanced recovery after surgery (ERAS) protocols, and increased patient satisfaction. Anesthesiologists must understand that there is a lack of standardized state regulations regarding ambulatory surgery centers (ASCs) and office-based surgery (OBS) centers. Current and recently graduated anesthesiologists should be aware of the safety concerns related to the various non-hospital-based locations, the sustained growth and demand for anesthesia in the office, and the expansion of mobile anesthesia practices in the US in order to keep up and practice safely with the professional trends. Continuing procedural ambulatory shifts will require ongoing outcomes research, likely prospective in nature, on these novel outpatient procedures, in order to develop risk stratification and prediction models for the selection of the proper patient, procedure, and surgery location.
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Young et al. (2023) conducted a review in Ambulatory and office-based surgeries. Ambulatory and office-based surgery vs. Inpatient hospital surgery was evaluated. The migration of increasingly complex surgical procedures and patients to ambulatory and office-based settings requires careful patient selection and safety protocols to maintain patient safety.
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