Patient Selection for Adult Ambulatory Surgery

A Narrative Review

Niraja Rajan, MD; Eric B. Rosero, MD, MSc; Girish P. Joshi, MBBS, MD, FFARCSI


Anesth Analg. 2021;133(6):1415-1430. 

In This Article

System Factors and Patient Selection

Recommendations and mandates from local, state, and national regulatory organizations influence decision-making regarding patient selection. For example, CMS limits ASCs to providing surgical services that do not require hospitalization and duration of such services would not exceed 24 hours.[12] Also, certain states have restrictions on types and length of procedures or upper and lower age limits for patients who may undergo a procedure in the ambulatory setting. For example, in Pennsylvania, children <6 months of age may not undergo surgery in an ASC.[13] Although these regulatory restrictions may not be based on current evidence, they must be followed.

The type of surgical facility also influences patient selection.[14] Unlike an ambulatory surgical facility that is physically connected to a hospital, a freestanding ASC may not be able to perform procedures on and care for patients of higher acuity because of lack of consultation and ancillary services, as well as lack of laboratory or blood bank services. Certain low-risk procedures such as cataract surgery or cystoscopy may be safely performed at freestanding ASCs on higher risk patients who would not qualify for a more invasive procedure at the same facility. Patient selection should be customized to each ASC based on its location and availability of consult and ancillary services.