High risk patients in day surgery.

Area of Science:

• Anesthesiology
• Surgical Outcomes
• Health Services Research

Background:

• Day surgery (DS) has expanded beyond healthy patients due to economic factors and medical advancements.
• Historically, only low-risk patients underwent DS, but current practice includes more complex cases.
• Mortality and major morbidity rates in DS are recognized as low.

Purpose of the Study:

• To discuss risk evaluation in day surgery (DS).
• To examine potentially risky situations and adverse outcomes in DS.
• To identify predictors of complications in outpatient procedures.

Main Methods:

• Review of current clinical practice and literature on day surgery risk assessment.
• Identification of risk factors including patient clinical status, surgical procedure, anesthesia, and facility type.
• Analysis of intermediate and late outcomes such as unplanned admissions or returns to hospital.

Main Results:

• Certain patient groups (e.g., decompensated cardiac/respiratory, OSA, elderly, preterm infants) face higher complication risks.
• ENT and urology DS procedures show higher rates of unplanned admissions.
• Outpatient tonsillectomy safety remains debated, with significantly lower mortality in DS centers compared to offices.

Conclusions:

• Comprehensive, team-based preoperative evaluation by expert anesthetists is essential for complex DS patients.
• Patient status is one factor; surgeon/anesthetist expertise, technique, and setting are also critical.
• DS centers must assess their own experience and outcomes before accepting high-risk patients for outpatient procedures.