Delayed discharge and acceptability of ambulatory surgery in adult outpatients receiving general anesthesia

Abstract

Purpose: Delay in discharge after ambulatory surgery impairs its cost-effectiveness. However, it is not self-evident that prolonged postoperative stay is associated with low quality of care and patient acceptability of ambulatory surgery. The aims of this study were to document factors affecting delay in discharge, recovery profiles, and patient acceptability in adult outpatients.

Methods: Perioperative data were collected prospectively on consecutive 726 adult same-day surgical patients receiving general anesthesia. Factors that affected home-readiness, discharge, and unanticipated admission were noted. Patients were followed up 24 h after discharge using a standardized questionnaire to identify postdischarge symptoms, patient's self-rated resumption of normal activity (RNA) level, and preference of outpatient procedure.

Results: Eighty-two percent of patients were discharged home <270 min after operation, 16% were delayed (> or = 270 min), and 2% required unanticipated admission. Delayed patients reported postdischarge pain more frequently (53%) and a lower 24-h postoperative RNA level (7.2 +/- 1.8) and preference ratio (76%) than no-delay patients (34%, 8.0 +/- 1.9, 87%, respectively; P < 0.001). Delay in home-readiness (> or = 165 min) was mainly due to an adverse symptom, and delay in discharge after reaching home-readiness (> or = 150 min) was mainly due to a persistent symptom (58%) or a social/system problem (34%). Causes of admission were perioperative complications (80%) or social reasons (20%).

Conclusion: Delays in discharge are mainly due to adverse symptoms or social/system problems. Delayed discharge is associated with increased postdischarge pain, lower RNA level, and patient acceptability. Appropriate care of postoperative symptoms and system management could prevent delay in discharge and improve patient RNA level and acceptability.