Ambulatory Surgery

Ambulatory
Surgery

  

• Swan
  BA, Maislan G, Traber KB,
  
  Symptom
  Distress and Functional Status Changes During the
  First Seven Days After Ambulatory Surgery
  
  Anesth
  Analg 86: 739-745, 1998
  
  
   
  
  
  Ambulatory
  surgery is being performed in sicker patients who
  may be at increased risk of perioperative morbidity.
  There is little information on how to ensure
  high-quality care while improving patient outcomes
  in this type of health care delivery.
  Most studies of ambulatory surgery have
  focused on morbidity, mortality, and unexpected
  hospitalization. To
  gain a more comprehensive appreciation of the
  response to surgery, perioperative changes in
  symptom distress and functional status were
  evaluated in patients undergoing ambulatory surgery.
  
    
  
  Participants
  included 123 patients undergoing one of two
  ambulatory surgical procedures; incisional inguinal
  hernia repair [41 patients] and diagnostic or
  interventional laparoscopy [59 patients].
  All patients were adults, aged 18 to 64
  years, and in American Society of
  Anesthesiologists’ [ASA] physical status I to III.
  Using the General Symptom Distress Scale, changes in
  symptom distress were studied at 24 hours and 4 and
  7 days after surgery. At the same time, basic and
  intermediate activities of daily living were
  assessed using the Functional Status Questionnaire.
  Change estimates were created with adjustment
  for age, ASA physical status, type of anesthesia and
  study site.  Patient
  responses indicated persistent symptom distress
  throughout the first postoperative week.
  In the hernia group functional status was
  significantly decreased.
  After laparoscopy, symptom distress appeared
  to be higher and functional status lower in older vs
  younger patients. By
  the end of the week less than a fourth of the
  patients had returned to work.
  
     
  
  In
  patients undergoing ambulatory surgery, symptom
  distress and decreased functional status, continue
  throughout the first week after surgery.
  
     
  
  Although these outcomes are not major
  surgical problems, they are clinically significant.
  As the use of ambulatory surgery continues to
  increase, careful assessment of discharge criteria
  will be essential to prevent complications occurring
  when the patient is recovering at home.