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

  • Zeev Friedman
  • Frances Chung
  • David T. Wong
General Anesthesia

Abstract

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.

Keywords

Congestive Heart Failure Obstructive Sleep Apnea Sleep Apnea Morbid Obesity Malignant Hyperthermia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

La sélection des patients adultes en chirurgie ambulatoire — enquête auprès des anesthésiologistes

Résumé

Objectif

Un nombre croissant de patients ayant des problèmes médicaux complexes est maintenant admissible à la chirurgie ambulatoire. Nous avons voulu vérifier la pratique clinique courante de sélection des patients pour la chirurgie ambulatoire.

Méthode

Un questionnaire normalisé présentant 30 conditions cliniques a été envoyé à tous les anesthésiologistes en exercice, membres de la Société canadienne des anesthésiologistes. Les répondants devaient indiquer par oui ou non s’ils offriraient une anesthésie ambulatoire à un patient adulte pour chacune de ces conditions isolées. Une adhésion à 75 % était considérée comme une opinion majoritaire.

Résultats

Nous avons reçu 774 réponses pour les 1 337 questionnaires envoyés, soit 57,8 %. Plus de 75 % des anesthésiologistes étaient disposés à inclure dans leurs critères de sélection des patients d’état physique III, selon l’American Society of Anesthesiologists (ASA), qui présentent une angine de poitrine (AP) d’évolution lente et une insuffisance cardiaque congestive (ICC), un infarctus du myocarde ancien, une valvulopathie asymptomatique, de l’apnée du sommeil sans usage de narcotiques, de l’obésité morbide (OM) sans comorbidités, un diabète insulino-dépendant et les patients susceptibles d’hyperthermie maligne peranesthésique. Au-delà de 75 % des répondants ont trouvé l’anesthésie ambulatoire inappropriée pour les patients ASA IV, les cas d’AP et d’ICC de haut degré, d’apnée du sommeil avec narcotiques postopératoires, d’OM avec comorbidités et pour les patients sans accompagnateur.

Conclusion

L’enquête démontre que pour les conditions médicales de sévérité extrême (modérée ou sévère) une majorité accepte ou n’accepte pas la chirurgie ambulatoire. Les enjeux qui recueillent plus de 75 % d’adhésion représentent la pratique courante. Ce type d’enquête pourrait faire partie de futures directives sur la sélection des patients.

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Copyright information

© Canadian Anesthesiologists 2004

Authors and Affiliations

  1. 1.Departments of AnesthesiaMount Sinai Hospital, University of TorontoTorontoCanada
  2. 2.Departments of AnesthesiaToronto Western Hospital, University of TorontoTorontoCanada

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