RECOVERY PATTERN AND HOME-READINESS AFTER AMBULATORY SURGERY

Despite increased use of ambulatory surgery, few data exist regarding patient recovery patterns and home-readiness. We prospectively identified the pattern of home-readiness, the persistent symptoms after surgery, and the factors that delay discharge after home-readiness criteria are satisfied. Five hundred patients were scored by the same investigator using the Postanesthetic Discharge Scoring System (PADSS) every 30 min, commencing 30 min after surgery, until the PADSS score was greater than or equal to 9. The same investigator telephoned each patient 24 h after discharge to administer a standardized questionnaire so that postoperative symptoms could be identified. Eighty-two percent of patients were discharged 2 h and 95.6% 3 h after surgery. These patients could have been discharged earlier. After home-readiness criteria were satisfied, some patients had delayed discharge because of the unavailability of immediate escorts or the recurrence of pain. Persistent symptoms delaying discharge occurred in 4.4% of patients. Patients who underwent certain ambulatory surgical procedures, such as laparoscopy or orthopedic and general surgery, had a sixfold increased risk of developing persistent symptoms in the ambulatory surgery unit. The time to home-readiness was 2.5-fold longer and the incidence of 24-h postoperative symptoms, two- to eightfold higher in the group with persistent symptoms in the ambulatory surgery unit. In summary, periodic objective evaluation of home-readiness revealed that the majority of patients would achieve a satisfactory score on or before 2 h after surgery. The time to home-readiness by objective evaluation correlated with the type of surgery. Most delays after satisfactory home-readiness scores were reached were due to nonmedical reasons. Patients with persistent postoperative symptoms in the ambulatory surgery unit correlated with increased 24-h postoperative symptoms.