Outpatient surgery contraindications

Ambulatory ASA patients I – IV have a similar rate of postoperative complications in the outpatient setting, with the caveat being that the ASA III and IV patients should have stable disease. The types of procedures performed should also not entail significant fluid shifts, postoperative pain, or require postoperative hospitalization.

Possibly poor candidates include those with poorly controlled diabetes, a history of substance abuse, patients with uncontrolled seizure disorders, susceptibility to malignant hyperthermia, potentially difficult airway, NPO < 8h, no escort, previous post –anesthetic adverse outcomes, significant drug allergies like latex, and those at risk for aspiration. Patients with obstructive sleep apnea (OSA) can require prolonged hospital stays as the ASA recommends that they be monitored for 3 hours post op on RA or for 7h s/p last episode of obstruction of hypoxemia. Thus, patients with OSA may also be poor candidates for an ambulatory procedure. The primary reason that patients get admitted or have delayed discharge home is for PONV.