Inguinal hernia repair is one of the most common surgical procedures worldwide and is frequently performed as day-case surgery. Postoperative pain may delay recovery and occasionally necessitate unplanned hospital admission. Regional anesthesia techniques, including transversus abdominis plane (TAP) and rectus sheath (RS) blocks, have shown promise in improving analgesia. However, their combined efficacy in open inguinal hernia repair has not been established in randomized trials. The PRO-RSTAP trial is a prospective, double-blind, four-arm randomized controlled trial conducted at three hospitals in Finland. The study evaluates the individual and combined effects of TAP and RS blocks in adults undergoing elective open inguinal hernia repair. Two hundred patients are randomized equally into four groups: (1) placebo TAP + placebo RS, (2) active TAP + placebo RS, (3) active RS + placebo TAP, and (4) active TAP + active RS. All patients receive standardized sedation and multimodal analgesia, including paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), and rescue opioids. The primary outcome is cumulative perioperative opioid consumption from block administration until hospital discharge, expressed as intravenous morphine equivalents. Secondary outcomes include pain scores, conversion to general anesthesia, postoperative nausea and vomiting, time to discharge, and unplanned admissions or emergency visits within 7 days. The planned sample size provides 80% power to detect a clinically meaningful reduction in opioid use (two-sided α = 0.05). Analyses follow the intention-to-treat principle. The first participant was enrolled in September 2025, and the trial is ongoing. No interim efficacy analysis is planned. Safety is monitored continuously throughout the study. This randomized controlled trial is designed to determine whether combining TAP and RS blocks improves postoperative analgesia and recovery after open inguinal hernia repair. The results will contribute to evidence-based optimization of regional anesthesia strategies in ambulatory surgery. EU Clinical Trials Information System (CTIS): 2024-513406-59-00; ClinicalTrials.gov identifier: NCT07423910.

The purpose of this study was to identify factors associated with delayed ambulation in patients undergoing radical prostatectomy in an ambulatory surgery setting. Patients who underwent ambulatory robot-assisted radical prostatectomy between January 11, 2016, and December 27, 2022, were eligible for inclusion. Predictors of interest included age, body mass index (BMI), American Society of Anesthesiologists physical status (1/2 vs 3/4), operative time, volume of intravenous fluids, estimated blood loss, intraoperative oral morphine equivalents, and postoperative nausea and vomiting (PONV) risk using 4-point Apfel scoring. The cohort included 3626 patients who underwent ambulatory prostatectomy. Median time to ambulation was 5.1 hours (IQR 4.2-6.3). Among predictors, only BMI and Apfel score were statistically significantly associated with ambulation. Patients with higher BMI were more likely to ambulate the same day of surgery; however, the effect size was small: A man with PONV risk score 2 and BMI 25 has a 94% chance of ambulating the same day compared with 95% for a man with BMI 30. A PONV risk score of 3 was associated with more than double the odds of next-day ambulation compared with scores ≤ 2 (odds ratio, OR 2.18, 95% confidence interval, CI, 1.69-3.66, P = .006). Our study identified an association between preoperative PONV risk score and delayed ambulation. Although high PONV risk is more commonly observed in women, our findings suggest that awareness of PONV risk and its management on postoperative ambulation should also be investigated in the context of prostate surgery.

The Transition of Total Joint Arthroplasty From Inpatient to Ambulatory Surgery Centers: Evolution, Evidence, and Implications.

Severe maternal morbidity and hypertensive disorders of pregnancy among women with intellectual disabilities: Identifying potential intervention targets.

Optimizing Patient Outcomes: Patient Selection and Anesthesia Considerations for Orthopedic Surgery in Ambulatory Surgery Centers.

Ambulatory surgery centers now perform more than 60% of the 60 million elective surgical procedures in the United States, yet artificial intelligence research in surgery has focused almost exclusively on hospital-based implementations. This evidence gap has implications for technology validation, investment decisions, and patient safety as ASCs adopt hospital-validated systems without setting-specific evidence. We conducted a scoping literature review searching PubMed, Scopus, Web of Science, and Cochrane Library from January 2020 through September 2025 for studies explicitly examining AI or machine learning applications in ASCs with quantitative outcomes. A parallel search using hospital-related terminology enabled direct comparison of research volume. After screening 847 potentially relevant articles, fewer than 10 studies specifically examined AI in ASC settings, while more than 500 hospital-based studies were identified during the same period. Existing ASC research focused on predictive analytics for workflow optimization; no studies examined intraoperative AI applications. The limited amount of ASC-specific research makes it unclear if hospital-validated benefits translate across settings to ASCs. A profound evidence gap exists between ASC surgical volume and ASC-focused AI research. The operational characteristics that distinguish ASCs from hospitals position them as ideal research settings for rigorous AI validation. Systematic ASC research is urgently needed to inform implementation decisions and establish data-standardization, technical, and economic frameworks required for the setting where most surgical patients receive care.

To compare bone fractures and fracture-related healthcare costs in individuals with and without spina bifida (SB). This is a retrospective observational trial. California's Healthcare Access and Information database was utilized to identify all individuals with SB who sought care in California emergency departments, inpatient hospitals, or ambulatory surgery centres between 2005 and 2017. Bone fracture encounters and associated healthcare utilization factors were compared among individuals with spina bifida vs individuals without spina bifida, matched 5:1 by birth year. Between 2005 and 2017, 20,290 individuals with spina bifida sought care in California emergency departments, inpatient hospitals, or ambulatory surgery centres. Compared with 101,450 individuals in the comparison group, those with spina bifida were more likely to seek care for a bone fracture (OR 1.64, p < 0.001) and more likely to sustain repeat fractures (36% vs 26%, p < 0.001). Individuals with spina bifida sustained more bone fractures per capita at each body location studied, with more than double the fractures per capita at the chest (2.0x), foot (2.1x), pelvis (2.4x), leg (2.5x), and vertebrae (2.5x). Individuals with spina bifida spent more cumulative days hospitalized for bone fractures (mean 9.4 vs 7.6, p < 0.001). Individuals with spina bifida were diagnosed with more bone fractures per capita than age-matched persons without spina bifida.

A Mixed-Methods Study of the Variation in Routine Preoperative Clinic Utilization.

Cementless total knee arthroplasty (TKA) has emerged as an alternative to cemented fixation. We used the American Joint Replacement Registry (AJRR) to assess trends in cementless TKA utilization and associated one-year revision rates. We analyzed primary TKAs recorded in the AJRR from 2012 to 2024 with available fixation data. Annual proportions of cementless fixation were calculated, and trend analyses were performed using Kendall Tau-b tests. The one-year revision risk was evaluated in cases linkable to Centers for Medicare and Medicaid Services (CMS) data among patients aged 65 years and older with at least two years of potential follow-up. A multivariable generalized linear model was used to estimate one-year revision risk, adjusting for patient and hospital characteristics and clustering by institution. A sub-analysis examined specific reasons for revision. Of 1,178,783 primary TKAs from 2012 to 2024, 127,781 (10.8%) were cementless. Use increased from 1.6 to 19.0% across all regions (P < 0.002). In the CMS-linked cohort (n = 685,274), 52,742 (7.7%) were cementless. The one-year revision rates were 1.61% for cementless and 1.53% for cemented TKAs (P = 0.162). After adjustment, cementless fixation was associated with increased revision risk (adjusted odds ratio (aOR) = 1.12; 95% confidence interval (CI): 1.00 to 1.25; P = 0.05). Revision risk was more strongly associated with age greater than 75 years (aOR = 0.76), men (aOR = 1.49), body mass index greater than 40 (aOR = 1.64), Charlson Comorbidity Index greater than 5 (aOR = 2.66), and hospital versus ambulatory surgery center (aOR = 4.78). Sub-analysis revealed higher risk of revision with cementless fixation for aseptic loosening (0.11 versus 0.06%; aOR = 2.37) and instability (0.14 versus 0.09%; aOR = 1.64). Cementless TKA utilization has grown in the AJRR. While associated with a modestly higher one-year revision risk, the absolute difference is small and may not be clinically meaningful.

Improving the Perioperative Outpatient Patient Experience: How Pre-op and PACU Made a Difference.

The safety and efficacy of outpatient primary total joint arthroplasty (TJA) in appropriately selected patients have been established. As rates of revision TJA (rTJA) continue to increase, there is growing interest regarding the complications and revision incidence among procedures performed in the outpatient setting. The purpose of this study was to report outcomes of revision TJA procedures performed at an ambulatory surgery center (ASC). A retrospective case series review of 181 patients undergoing aseptic rTJA at a free-standing ASC between January 1, 2017, and July 1, 2024, at a single large academic referral center was performed. Patients who did not have a minimum 1-year follow-up were excluded (n = 28). Our primary outcome was the incidence of complications within 90 days of rTJA, with our secondary outcome as the incidence of re-revision at final follow-up. A majority of patients underwent modular component exchanges (75.7%), with instability being the most common revision etiology (71.8%). The mean follow-up was 3.4 years (range, 1.1 to 8.6). A Kaplan-Meier survival analysis was performed to identify survivorship free of all-cause re-revision at two and five years postoperatively. There was one patient (0.6%) who developed a DVT within 90 days postoperatively. There were no other medical complications seen among included patients. There were five patients (2.8%) who required reoperation in the initial 90 days due to PJI (n = 3) and wound complications (n = 2). Wound complications were the most common surgical complication (n = 9.5%). A total of 20 patients (11%) experienced any complication within 90 days. Survivorship free from all-cause re-revision was 96.7% (95% CI [Confidence Interval]: 92.7 to 98.5) at two years and 94.1% (95% CI: 87.9 to 97.2) at five years. Our study found that patients undergoing outpatient rTJA had a low rate of various complications in the immediate postoperative period as well as low rates of re-revision at short-term follow-up. These findings suggest that with careful patient and procedure selection, revision TJA may safely be performed at an ASC.

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are used for glycaemic lowering, weight loss and cardio-renal protection. GLP-1RAs delay gastric emptying and are implicated in perioperative pulmonary aspiration. Cataract eye surgery is the most common outpatient surgical procedure using mild-to-moderate sedation (MMS). We evaluated whether GLP-1RA use is associated with perioperative desaturation and/or postoperative nausea or vomiting (PONV) during ambulatory ophthalmic surgery using MMS. A retrospective, observational cohort study of adults who underwent surgery under MMS at the Kensington Eye Institute between January 2022 and December 2024 was conducted. Patients were classified as GLP-1RA users or non-users. Primary outcomes were desaturation < 90% and PONV requiring antiemetic administration. Associations were assessed using univariate and multivariable logistic regression adjusted for risk factors and potential confounders using a generalized estimating equation (GEE) approach. A total of 45 636 visits from 30 328 eligible patients were included, of which 1596 (3.5%) visits from 1036 patients were GLP-1RA users. GLP-1RA use was not associated with incidence of desaturation [OR(95% CI): 1.22 (0.38-3.88), p = 0.74]. GLP-1RA use was associated with an increased likelihood of PONV requiring antiemetics [OR(95% CI): 1.93 (1.29-2.89), p = 0.001]. No perioperative or 24-h postoperative aspiration events were identified in either group. In this cohort, no desaturation events occurred, although PONV was more frequent amongst GLP-1RA users. These findings support the safety of continued perioperative GLP-1RA use in patients meeting strict institutional pre-procedure screening pathways for short-duration ophthalmic surgeries under MMS in an ambulatory setting but may not extend to higher risk patients excluded by institutional criteria. Future guidelines need to incorporate patient-centred symptomatology to guide clinicians in perioperative management of GLP-1RA use.

This multidisciplinary consensus statement aims to update the 2013 American Thyroid Association statement on outpatient thyroidectomy by refining the eligibility criteria for safe ambulatory thyroid surgery based on interval published data. Evidence-based perioperative factors essential for optimizing ambulatory care after thyroid surgery are outlined here. This summary statement highlights four essential aspects for safe outpatient thyroid surgery evaluating preoperative eligibility, optimizing operative planning and techniques, implementing structured postoperative protocols, and ensuring effective preparation for and management of complications. Various factors may serve as relative contraindications to ambulatory thyroid surgery, including patient comorbidities, as well as clinical, social, procedural, and facility-related characteristics. Key operative factors include the choice of anesthesia, use of nerve monitoring, hemostasis, surgical technique, and management of the parathyroid glands. Postoperative care should include clear discharge criteria and protocols that ensure prompt identification and management of complications, including bleeding, airway compromise, and significant hypocalcemia. Ensuring patient education and fostering collaboration among nursing staff, surgeons, and anesthesiologists to develop treatment pathways are essential for the success of ambulatory thyroid surgery. They optimize the patient experience and long-term outcomes while mitigating perioperative risks. Ambulatory thyroid surgery can be performed safely in carefully selected and well-informed patients, provided appropriate precautionary perioperative measures are implemented to enhance communication and improve patient outcomes.

This study aimed to identify the discharge readiness level of ambulatory surgery patients and examine the effects of these variables on the discharge readiness of ambulatory surgery patients. A cross-sectional quantitative design was used. A convenience sample of 212 patients undergoing ambulatory surgery between January 2022 and June 2023 was enrolled. Discharge readiness, quality of discharge teaching, health literacy and family support were measured. Pearson correlation and multiple linear regression were used to examine associations and explanatory factors. It was determined that the discharge readiness of patients with ambulatory surgery was at a medium level (91.10 ± 8.53). Discharge readiness was positively associated with quality of discharge teaching (r = 0.703, p < 0.01), health literacy (r = 0.503, p < 0.01) and family support (r = 0.305, p < 0.01). Stepwise multiple linear regression showed that quality of discharge teaching (β = 0.613, p < 0.001), health literacy (β = 0.205, p < 0.001), surgical specialty (ophthalmology: β = 0.370, p < 0.001; otorhinolaryngology: β = 0.138, p = 0.002), age groups (45-59 years: β = -0.106, p = 0.012; 75-89 years: β = -0.175, p < 0.001), family support (β = 0.112, p = 0.007), living arrangement (β = 0.101, p = 0.011) and occupation (retirement: β = -0.095, p = 0.041) were significantly associated with discharge readiness. The final model was statistically significant (adjusted R2 = 0.682), explaining 68.2% of the variance in discharge readiness. Discharge readiness of ambulatory surgery patients was moderate. The quality of discharge teaching, health literacy, surgical specialty (ophthalmology, otorhinolaryngology), age groups (45-59 and 75-89 years), family support, living arrangement and occupation (retirement), which cover multiple dimensions such as spanning personal, environmental, family and therapeutic factors, were associated with discharge readiness. Data were collected via questionnaire from participants. Findings can inform personalised discharge preparation programs to improve the discharge readiness of day surgery patients. This study was reported in accordance with the STROBE guidelines.

Postoperative Nausea and Vomiting Management, New Drugs in the Outpatient Setting.

Management of Cardiac Implantable Electronic Devices in the Ambulatory Setting.

Artificial Intelligence in the Ambulatory Surgery Center.

Neuromuscular Blockade Use and Monitoring Practices Reported by Anesthesiology Providers Practicing in Ambulatory Surgery Settings.

A Contemporary Review on Health Care Disparities in Pediatric Ambulatory Anesthesia.

BACKGROUNDExposure to second-hand smoke (SHS) from parents increases paediatric peri-operative respiratory risk, yet peri-operative screening and counselling are rarely implemented.OBJECTIVETo assess whether a single brief counselling session delivered during the paediatric ambulatory surgery pathway increases parental awareness of SHS harms and influences short-term self-reported behaviour.DESIGNProspective observational before–after study with 30-day follow-up.SETTINGSingle-centre tertiary-level university hospital ambulatory surgery unit, Liège, Belgium; data collected from 7 November 2024 to 27 March 2025.PATIENTSParents who self-reported active tobacco use and whose child was scheduled for elective paediatric ambulatory surgery at the University Hospital of Liège, Belgium. Of 43 eligible dyads, 31 parents consented and completed baseline and immediate postintervention questionnaires; 26 completed 30-day follow-up.INTERVENTIONOne standardised ~15-min counselling session by a certified tobacco counsellor covering types of smoke exposure, health and anaesthetic risks and practical measures to reduce household exposure.MAIN OUTCOME MEASURESPrimary outcome was change in a summed awareness score (six items, 0 to 10 each; total 0 to 60) from precounselling to immediate postcounselling. Secondary outcomes included item-level changes, session acceptability and self-reported behavioural change at 30 days.RESULTSA brief peri-operative counselling session markedly improved parental awareness of SHS. At 30 days, self-reported behavioural change remained modest. The awareness score was exploratory and not formally validated. Randomised studies with objective exposure measures and longer follow-up are needed.CONCLUSIONA single brief peri-operative counselling session improved parental awareness of SHS harms, with limited short-term impact on self-reported behaviour.TRIAL REGISTRATIONNCT07144982. Approved by the Comité d’Ethique Hospitalo-Facultaire Universitaire de Liège; President: Professor D. Ledoux; IRB number: 707 (Belgian ref. B7072024000085; internal ref. 2024/327).