Advancements in recent years have allowed for some complex medical procedures to now be safely performed in outpatient surgery centers. Richard Novak M.D., a Stanford physician, estimates that 70% of elective procedures may be conducted in an outpatient facility. The majority of these surgeries require administration of anesthesia. As a result of many negative outcomes, providers and administrators have had to reassess which patients are (or are not) suited for having procedures in the outpatient setting. The process is referred to as determining a measurement of operative risk, which is critical in today's litigious environment of professional medical liability.
The American Society of Anesthesiologists (ASA) explains that certain patients may not be safe candidates for undergoing office-based procedures, but may be suitable for procedures in an ambulatory surgery center (ASC) setting. Similarly, patients with advanced conditions may be unfit for outpatient surgery center procedures and require exclusively hospital-based surgery. Anesthesia providers often are the last professional to evaluate a patient's appropriateness for outpatient surgery.
Considerations & Red Flags in Patient Selection
In making a determination whether a patient is appropriate for surgeries involving anesthesia outside of a hospital setting, some general considerations include:
- The patient's age. Actually, less emphasis is placed on their actual age, but rather their overall health and level of functioning.
- Whether major irregularities exist in critical organs
- If they have hindrances in maintaining a proper airway such as a significant overbite or oversized tongue
- Whether they are morbidly obese
- If they require continuous positive airway pressure (CPAP) for problems with sleep apnea
- If they have previously had anesthesia-related complications
- Medications that may negatively react with anesthesia
- A significant history of alcohol or drug abuse
Risks Specifically for ASC Surgical Procedures
Making a proper evaluation regarding whether a patient is a risk for ASC-based surgeries involving anesthesia can involve identifying key health conditions that may exist as well as groups of multiple lower-risk conditions. Those with symptoms associated with coronary disease are a concern, specifically those with dysrhythmias (abnormal heartbeat), heart valve problems, or those with a pacemaker. Those with a history of stroke are riskier, particularly if lingering effects exist. Major respiratory conditions are always a risk, such as severe cases of asthma or COPD.
Conditions Requiring Postponement of ASC Procedures for Reassessment
There are a few conditions that warrant postponement of a procedure until a reevaluation or reassessment is completed regarding their appropriateness for surgery involving anesthesia in an outpatient setting including:
- The combination of requiring CPAP for sleep apnea and being morbidly obese (over 40 BMI)
- Patient is pregnant (for certain procedures)
- Uncontrolled diabetes, such as a fasting sugar level of 200 or under 60
Conditions Requiring Definite Cancellation of ASC Procedures
- Had a heart attack in the past 30 days
- Sudden presence of chest pain (angina)
- Recent symptoms of irregular heartbeat (Atrial fibrillation)
- Extremely high blood pressure levels
- Dependency on oxygen when combined with additional other conditions (comorbidities)