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Preoperative Evaluation/Patient Issues/Duration of procedure

QUESTION:

We do a significant number of cosmetic surgeries at our ambulatory surgery center. Some of these operations last well over six hours. We are currently considering limiting the length of surgery that can be performed without an automatic overnight admission for observation. Are there any guidelines or recommendations currently available to assist in this decision process?

-- From C.C., M.D., Tampa, FL

REPLY:

As you so correctly indicate, many cosmetic surgery procedures can last several hours, and many/most are scheduled as same-day procedures. Unfortunately there are no guidelines or recommendations I am aware of regarding the upper limit of surgical duration which is appropriate for same-day surgery. Although there is evidence in the literature suggesting that longer surgery is associated with both an increased duration of PACU stay and an increased risk of unanticipated overnight admission after ambulatory surgery, these studies provide no information to help formulate specific length-of-procedure guidelines.
I assume you are already tailoring your anesthetic to optimize recovery from these prolonged ambulatory anesthetics. It may also be a good idea to schedule them first thing in the morning to optimize the availability of recovery area nurses and other support personnel at the conclusion of the procedures. I would recommend that you collect data regarding the length of surgery and the duration of postoperative stay and frequency of overnight admission at your center, and make any decisions regarding the maximum length of surgery based on this information.

-- From D. Daley, M.D., Houston, TX

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