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Postoperative Issues/Who should stay with a patient overnight after a procedure?

QUESTION:

It is generally accepted that patients should be accompanied by an adult when they are discharged home from ambulatory surgery, but does anyone have any policies about requiring someone to actually stay with the patient overnight after their ambulatory surgery?

-- Anonymous

REPLY:

This is an excellent question, for which there is no simple answer. Unfortunately, there are no anesthesia or surgical organizations I am aware of who have published guidelines, practice parameters and/or policies regarding this topic. As well, there are no studies in the literature which specifically address this issue.

I believe the main concerns regarding having a patient spend the night alone after their surgery are: 1. will the patient be able to identify and obtain help for any postoperative problems which require urgent medical attention (eg. bleeding, uncontrollable nausea and vomiting…) ?; 2. will the patient be able to perform the necessary functions of daily living (eg. obtaining food and drink, using the toilet…) and/or manage his/her underlying medical conditions (eg. diabetes) despite potential limitations imposed by the anesthesia and/or surgery? Whether these concerns become actual problems will depend on a variety of factors, including the magnitude of the surgery, body area(s) effected by the surgery, type of anesthetic, underlying functional capacity (mental and physical) of the patient, and the presence of underlying medical conditions requiring special attention (such as diabetes with the need for blood glucose monitoring and insulin adjustments). On one extreme will be the young healthy adult having minimal sedation for very minor surgery, and on the other extreme will be the elderly patient with multiple medical problems who is barely able to function independently at the best of times and who has had one of the more invasive procedures which is "pushing the limit" for ambulatory surgery.

In the absence of guidelines from professional organizations or the literature, it is necessary for each institution to examine their patient populations to determine whether they should consider requiring a responsible adult to remain with the patient overnight on the day of surgery, either on a selective and/or universal basis. Unlike the requirement for patients to be discharged home accompanied by a responsible person, this stay-overnight requirement is not directly enforceable. However, proper patient education and early preoperative identification of those who will require this overnight care should aid considerably in maximizing cooperation with such policies.

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

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