Same-Day Discharge Ambulatory Surgery Centers: The Importance of Preoperative Workup for Aesthetic Surgery Patients.

Abstract

Background: Limited resources combined with an increasingly 'cost-conscious' approach to healthcare has resulted in a reduction of preoperative investigations that have been deemed unnecessary. While this approach may work in the hospital setting where ancillary services and emergency support are readily available, it may actually be impacting patient safety in the ambulatory surgery center (ASC) setting.

Objectives: The purpose of this study was to determine the prevalence of abnormal results arising from routine preoperative workup amongst patients undergoing aesthetic surgery in the outpatient ASC setting. The goal was to examine whether abnormal results led to alterations in care that otherwise would not have been made had the workup not been performed, and to outline patient factors associated with alterations in care.

Methods: A retrospective chart review was performed of 2,596 consecutive patients who underwent aesthetic surgery over a 40-month period at a single Canadian ambulatory surgery center. Data collected included patient demographics, procedural characteristics, and outcomes. Preoperative workups were categorized as either required (for patients with positive findings on medical history and/or physical examination) or supplementary (for otherwise healthy patients).

Results: A total of 2,581 patients met inclusion criteria for the study. The majority of patients were female (91.2%) and underwent breast surgery (60.3%). All patients underwent independent preoperative medical history and physical examination with bloodwork/screening. In total, 838 patients (32.5%) had abnormal bloodwork results while 240 (9.3%) had abnormal ECGs. These abnormal tests resulted in alterations in care for 242 patients (9.4% of total patients with 293 unique care alterations). Alterations in care included pharmacotherapy (n=104, 35.5%), additional investigations (n=78, 26.6%), specialist consultations (n=67, 22.9%), and postponement of surgery (n=44, 15.0%). Demographic variables associated with alterations in care included: age ≥50 (p<0.00001), female sex (p=0.0235), higher ASA class (p<0.00001), and preexisting medical comorbidities (p<0.00001).

Conclusions: Preoperative workups are an important factor for improving patient safety in outpatient aesthetic surgery. These investigations can uncover occult issues that may increase the risk of complications in the ASC setting.