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Surgical procedures suitable for ambulatory surgery should be accompanied by minimal postoperative physiologic disturbances and an uncomplicated recovery.[28] [29] The primary predictors of prolonged stay or unanticipated admission after day-case surgery are related to the surgical procedure (e.g., blood loss, pain, postoperative nausea and vomiting [PONV]).[30] With advances in surgical technologies and the rapid growth in minimally invasive ("keyhole") surgery, an even wider variety of operations can now be performed on an outpatient basis ( Table 68-2 ). Many published reports have suggested that minimally invasive outpatient procedures such as parathyroidectomy and thyroidectomy, laparoscopically assisted vaginal hysterectomy, removal of ectopic tubal pregnancy, and ovarian cystectomy, as well as laparoscopic cholecystectomy and fundoplication, offer many advantages over conventional hospital-based approaches.[31] [32] [33] [34] [35] [36] [37] In addition, procedures such as laparoscopic adrenalectomy, splenectomy and nephrectomy, lumbar microdiskectomy, and video-assisted thoracic surgery can improve recovery and reduce costs when compared with "open" procedures.[38] [39] Other superficial procedures such as mastectomy have been alleged to be associated with a reduction in both cost and
| Specialty | Types of Procedures |
|---|---|
| Dental | Extraction, restoration, facial fractures |
| Dermatology | Excision of skin lesions |
| General | Biopsy, endoscopy, excision of masses, hemorrhoidectomy, herniorrhaphy, laparoscopic procedures, varicose vein surgery |
| Gynecology | Cone biopsy, dilatation and curettage, hysteroscopy, laparoscopy, polypectomy, tubal ligation, vaginal hysterectomy |
| Ophthalmology | Cataract extraction, chalazion excision, nasolacrimal duct probing, strabismus repair, tonometry |
| Orthopedic | Anterior cruciate repair, arthroscopy, bunionectomy, carpal tunnel release, closed reduction, hardware removal, manipulation under anesthesia |
| Otolaryngology | Adenoidectomy, laryngoscopy, mastoidectomy, myringotomy, polypectomy, rhinoplasty, tonsillectomy, tympanoplasty |
| Pain clinic | Chemical sympathectomy, epidural injection, nerve blocks |
| Plastic surgery | Basal cell cancer excision, cleft lip repair, liposuction, mammaplasty, otoplasty, scar revision, septorhinoplasty, skin graft |
| Urology | Bladder surgery, circumcision, cystoscopy, lithotripsy, orchiectomy, prostate biopsy, vasovasostomy |
| From White PF (ed): Ambulatory Anesthesia and Surgery. London, WB Saunders, 1997. | |
Patients undergoing procedures that are likely to be associated with postoperative surgical complications or major fluid shifts should be admitted to the hospital overnight. Although autologous blood transfusions are used for more extensive outpatient plastic surgery (e.g., reduction mammoplasty, liposuction), lengthy procedures associated with excessive fluid shifts should be handled in an overnight (23-hour) recovery facility. Similarly, operative procedures requiring prolonged immobilization and parenteral opioid analgesic therapy are more ideally suited to a 23-hour stay. The availability of newer analgesic therapies (e.g., continuous local anesthetic infusions) and ambulatory patient-controlled analgesia (e.g., subcutaneous, intranasal, transcutaneous) may alter the latter recommendation in the future.[41] [42] [43]
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