A critical analysis of factors leading to next-day discharge in ambulatory surgery patients

Abstract

Ambulatory surgery (AS) is becoming the rule. However, some patients do not have AS despite correct indications. The purpose of this retrospective study of prospectively collected data was to analyze why these patients do not have AS and evaluate their immediate post-operative course, in order to broaden the indications for AS. Between January and December 2013, the reasons why patients who had appropriate indications for ambulatory cholecystectomy or hernia repair but later had conventional hospital management were recorded. The primary endpoint was early post-operative morbidity. Secondary endpoints were demographic, surgical, anesthetic, post-operative data as well as analysis of criteria leading to conventional hospital stay. Among 410 patients undergoing surgery for accepted AS indications, 158 (39%) did not have AS; 113 out of these patients (72%) were discharged the day following surgery. Of the 69 patients (43.6%) who did not have AS for medical reasons (50 by the surgeon's decision alone), 60 patients could have undergone AS since their outcome was uneventful in 96% of cases; only three patients (2.5%) had post-operative complications. The AS rate could have been increased by 15% through better surgical and anesthetic collaboration.