Preoperative assessment and preparation.

The practice of ambulatory surgery is rapidly expanding, not only the type of surgeries performed, but more "at risk" patients are being allowed outpatient procedures. Warner and colleagues [56] recently published the results of a large prospective outcome survey of morbidity and mortality after ambulatory surgery. Of the 38,598 patients studied, 31 patients experienced a major morbidity (1:1455) and 4 died (2 myocardial infarctions and 2 motor vehicle accidents) (Table 7). There were no deaths secondary to medical complications within the first week after ambulatory surgery. Furthermore, the morbid events were equally distributed among the various ASA classification categories (Table 8). Given the overall low morbidity and mortality rates, it is likely that ambulatory surgery will continue to grow in the future. Improved preoperative assessment and preparation will further increase the number of acceptable candidates for ambulatory surgery. Having recognized the special needs of the surgical outpatient, anesthesiologists should modify their practice patterns to meet the psychological and pharmacological requirements of the outpatient undergoing an elective surgical procedure.