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Factors affecting recovery and discharge following ambulatory surgery

[Les facteurs influençant la récupération et la sortie après une opération en chirurgie ambulatoire]

From the Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.

Address correspondence to: Dr. Frances Chung, Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst St., McL 2-405, Toronto, Ontario M5T 2S8, Canada. Phone: 416-603-5118; Fax: 416-603-6494; E-mail: frances.chung{at}uhn.on.ca

Purpose: Recovery and discharge following ambulatory surgery are important components of the ambulatory surgery experience. This review provides contemporary perspectives on the issues of discharge criteria, fast-tracking, patient escort requirements, and driving after ambulatory anesthesia.

Source: A search was performed in the Cochrane Central Register for Controlled Trials, MEDLINE®, EMBASE®, CINAHL, and PsycINFO, to review factors delaying discharge following ambulatory surgery. The following subject headings were used: "ambulatory surgery, discharge, recovery, car driving, escort, transport, fast tracking, patient discharge, recovery, transportation of patients, hospital discharge, recovery room, patient transport, hospital discharge, recovery room, anesthetic recovery, patient transport, ambulatory surgical procedures, patient discharge, recovery of function, automobile driving, patient escort service, recovery room". Using the same search engines, the following keywords were used: "fast tracking, recovery, and discharge".

Principal findings: The current literature supports that discharge scoring systems may be useful to guide discharge following ambulatory surgery. While fast-tracking has become common in some centres, further studies are required to justify more routine implementation of this practice in the management of patients undergoing ambulatory surgery. Patients at low risk for urinary retention can be discharged home without voiding. Patients should not drive until at least 24 hr postoperatively.

Conclusions: Ensuring rapid postoperative recovery and safe discharge following ambulatory surgery are important components of the ambulatory surgical program. A clearly defined process should be established for each ambulatory surgical unit to ensure the safe and timely discharge of patients after anesthesia, in accordance with current best evidence.

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				B. A. Williams and M. L. Kentor Fast-track ambulatory anesthesia: impact on nursing workload when analgesia and antiemetic prophylaxis are near-optimal Can J Anesth, March 1, 2007; 54(3): 243 - 244. [Full Text] [PDF]