Outpatient vs. Inpatient Surgery (Anesthesia Text)



Some data that suggest both morbid obesity [Davies et. al. Anaesthesia 56: 1090, 2001] and obstructive sleep apnea [Sabers et. al. Anesth Analg 96: 1328, 2003] are not predictors of re-admission or delayed discharge from ambulatory anesthesia. ASA III (and possibly IV [Barash]) should not be excluded if their diseases are under control [Ansell et. al. Br J Anaesth 92: 71, 2004]. Length of surgery is not a criteria as there is little if any relationship between duration of surgery and recovery [Barash]. Note that any preterm infant with post-gestational age < 50 weeks should not be discharged for at least 23 hours because of the risk of apnea

University of Virginia Policies and Considerations

UVa no longer has a 350 lb limit, however keep in mind that emergency intubation equipment is limited and there are no ventilators other than in the OR (ie anyone with a prolonged anesthetic must remain in the OR)

Consensus Statement

(from [Anesthesiology 104: 1081, 2006])

Procedures That May Be Safely Performed on an Outpatient Basis for Patients with OSA

Type of Surgery/Anesthesia Opinion
Superficial surgery/local or regional anesthesia Agree
Superficial surgery/general anesthesia Equivocal
Airway surgery (adult, e.g., uvulopalatopharyngoplasty) Disagree
Tonsillectomy in children less than 3 years old Disagree
Tonsillectomy in children greater than 3 years old Equivocal
Minor orthopedic surgery/local or regional anesthesia Agree
Minor orthopedic surgery/general anesthesia Equivocal
Gynecologic laparoscopy Equivocal
Laparoscopic surgery, upper abdomen Disagree Lithotripsy Agree