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Ambulatory surgery adult patient selection criteria – a survey of Canadian anesthesiologists

[La sélection des patients adultes en chirurgie ambulatoire – enquête auprès des anesthésiologistes]

Zeev Friedman, MD^*, Frances Chung, FRCPC and David T. Wong, MD

^* From the Departments of Anesthesia, Mount Sinai Hospital; and
The Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.

Address correspondence to: Dr. Frances Chung, Department of Anesthesia, Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada. Phone: 416-603-5118; Fax: 416-603-6494; E-mail: frances.chung{at}uhn.on.ca

Purpose: An increasing number of patients with complex medical problems are now considered suitable for ambulatory surgery. The purpose of this study was to identify the current clinical practice of ambulatory surgical patient selection.

Methods: A standardized questionnaire specifying 30 clinical conditions was sent to all practicing anesthesiologists who are members of the Canadian Anesthesiologists’ Society. Recipients were asked to indicate if they would provide ambulatory anesthesia (yes/no answers) for an adult patient with each of those isolated conditions. A 75% agreement was considered a majority opinion.

Results: One thousand three hundred thirty-seven questionnaires were sent and 774 replies were received (57.8%). Over 75% of anesthesiologists were willing to include in their selection criteria American Society of Anesthesiologists’ (ASA) physical status III, patients with low-grade angina pectoris (AP) and congestive heart failure (CHF), prior myocardial infarction, asymptomatic valvular disease, sleep apnea without use of narcotics, morbid obesity (MO) without co-morbidities, insulin dependent diabetes mellitus and malignant hyperthermia (MH) susceptible patients. Over 75% of responders found ASA IV patients, high grade AP and CHF, sleep apnea with postoperative narcotics, MO with co-morbidities and no patient escort to be unsuitable for ambulatory anesthesia.

Conclusion: Our survey demonstrated that medical conditions with extreme grades of severity (mild or severe) are associated with majority opinion to proceed or not to proceed with ambulatory surgery. Issues with over 75% agreement reflect the common practice. Similar surveys may form a part of patient selection guidelines development in the future.

This article has been cited by other articles:

				F. Chung, N. Imasogie, J. Ho, X. Ning, A. Prabhu, and B. Curti Frequency and implications of ambulatory surgery without a patient escort: [La frequence et les implications de la chirurgie ambulatoire de patients non accompagnes] Can J Anesth, December 1, 2005; 52(10): 1022 - 1026. [Abstract] [Full Text] [PDF]