Patient Selection Criteria for Surgery and Interventional Pain Management Procedures Performed in Ambulatory Settings

Surgeons perform most surgical procedures in outpatient settings: hospital-based ambulatory surgical units, freestanding ASCs, or office-based surgery facilities (see the article by Haeck et al.). These ambulatory surgical facilities provide surgical care to patients who do not require hospital admission for postoperative care. Ambulatory surgery can offer several advantages over hospitalization for patients and providers, including (see Office-based Surgery Guidelines from the Massachusetts Medical Society and the article by Haeck et al. ):

Possible disadvantages of ambulatory surgery include:

Over the last 3 decades, the volume of outpatient surgery procedures has more than tripled to nearly 57 million procedures annually with 14 million performed on elderly patients. During this period, the setting where physicians perform these outpatient procedures has shifted. Once exclusively performed in hospital-based ambulatory surgical units, physicians now perform a greater volume of outpatient procedures in freestanding ASCs and their private offices, where visits have increased more than 300% during the past decade. The number of ASCs has more than doubled since the 1990s, and more than 5,000 ASCs operate nationwide. Most freestanding ASCs are owned or partially owned by the physicians who staff the facilities. (See articles by Hollenbeck et al. and Manchikanti et al. )

Advances in anesthetic and surgical techniques have increased the complexity of procedures performed in ASCs, and "there has been an increasing shift to performing procedures in ASCs on patients who have more complex medical conditions, including some that have been associated with a heightened risk of adverse postoperative outcomes," according to the Pennsylvania Patient Safety Authority (PSA). (See PSA article Patient Screening and Assessment in Ambulatory Surgical Facilities. )

Factors identified that predict an increased risk for hospital admission or death after outpatient surgery are as follows (see the article from PSA on Patient Screening and Assessment in Ambulatory Surgical Facilities):

Additional factors that may put a patient at risk in ambulatory settings include a history of transient ischemic attack/stroke, previous cardiac surgical intervention, overweight or obese body mass index, and a diagnosis of asthma, chronic obstructive pulmonary disease, diabetes mellitus, hypertension, or obstructive sleep apnea (see the articles by Mathis et al. and Kataria et al. ...