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


The process of patient selection for ambulatory surgery needs to be a careful consideration of the interplay of patient, procedure, anesthetic, social, and system factors (Table 2). Development of prediction tools that would allow determination of procedure suitability and patient eligibility for the ambulatory setting should improve patient safety.[10] Procedure-related predictors of adverse outcomes could be used to determine the optimal surgical setting as well as allow triaging of high-risk patients for preoperative optimization.[13] Developing and implementing protocols (or clinical pathways) for patient selection and prehabilitation would further enhance patient safety and efficiency.[15] This requires a multidisciplinary approach in which the anesthesiologist should take a lead in collaborating with the surgeons and the perioperative nurses.[15,132] Conundrums likely to be faced by ambulatory anesthesiologists in the near future include caring for recently hospitalized patients, patients using medical or recreational marijuana, patients with learning disabilities and or psychiatric illnesses, and patients with post–coronavirus disease 2019 (COVID-19) syndrome. While none of these conditions preclude outpatient surgery, these patients may require specific preparation and considerations before and on the day of surgery. In the future, as more patients and surgical procedures are moved from inpatient to outpatient facilities, it is advisable to develop procedure-specific exclusion criteria for patients that are not candidates for ambulatory surgery. A pragmatic question to ask is: Will postoperative hospitalization influence patient care or perioperative outcome? If no improvement would be achieved, then the patient should undergo the procedure on an ambulatory basis.