Criteria for Outpatient Venues

Is my patient a candidate for an outpatient procedure?

Today, many operations and diagnostic procedures are performed in outpatient centers, and modern, short-acting anesthetics facilitate quick recovery and early discharge.

However, some patients may not be appropriate candidates for outpatient procedures if they are at increased risk for anesthesia complications due to significant underlying health problems.

This decision must be individualized. The same patient might be an appropriate outpatient candidate for a minor, superficial procedure with local anesthesia and minimal or moderate sedation, but might be at risk for unplanned admission to the hospital if the surgical procedure is more invasive or requires general anesthesia. (Please refer to the section on “Risk Stratification” for further information on evaluating medical risk in the context of surgical risk.)

Here are general guidelines listing medical conditions that typically require a procedure to be performed in a hospital rather than an outpatient center. At the discretion of the anesthesiologist, these may be waived under appropriate circumstances or for minor procedures.

• Anemia or coagulopathy that might require transfusion
• Cardiovascular disease, severe or symptomatic:
  • Aortic stenosis
  • Arrhythmia
  • Cardiomyopathy with reduced LVEF (less than 40 percent)
  • Carotid artery disease
  • Congestive heart failure
  • Coronary artery disease
  • History of complex congenital heart disease
  • Pulmonary hypertension
  • Valvular disease
• Chronic pain syndrome, opioid dependence
• Epilepsy or seizure disorder, if not well controlled
• Liver disease, severe:  Model for End-Stage Liver Disease (MELD) score greater than 10
• Morbid obesity, with BMI greater than 40
• Musculoskeletal disease:  Myasthenia gravis, muscular dystrophy (if procedure requires general anesthesia)
• Obstructive sleep apnea, moderate or severe (airway procedures, laparoscopic surgery, or upper abdominal surgery)
• Pregnancy: Termination of pregnancy is not advised in an outpatient facility if gestational age is greater than 16 weeks
• Pulmonary disease:
  • Severe COPD
  • Pulmonary fibrosis

Special pediatric considerations:

• Premature infants who were less than 37 weeks conceptual age at birth are considered at high risk for apnea until they reach at least 52 weeks

• Full-term infants should not have outpatient procedures until they reach at least 44 weeks conceptual age

• Children with complex congenital heart disease, craniofacial abnormalities, or other serious medical problems should receive care in the hospital setting

• Children under 3 years of age should not be scheduled for tonsillectomy at an outpatient venue