“While the overall safety record of ASC procedures is impressive and the rate of complications in an ASC is very low, a number of complications that lead to transfers can potentially be avoided with conducting thorough preoperative assessments,” she says. “A thorough and detailed preoperative assessment is important to identify medical problems in surgical patients, determine a patient’s level of risk for a specific procedure, determine need for additional diagnostic testing and decide the best course of action in managing a patient’s medical problems during surgery or determine if the patient is even a candidate for the outpatient setting.”
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Ms. Allison says cardiac, respiratory and bleeding complications are the most common adverse complication events occurring during ambulatory surgery, but ASCs can take steps to reduce the likelihood of them occurring.
Cardiovascular complications
To identify patients at risk for cardiovascular adverse events, she advises ASCs to follow the guidance by the American College of Cardiology and American Heart Association on perioperative cardiovascular evaluation for noncardiac surgery:
- Identify risk factors for coronary heart disease as well as cardiac conditions such as prior angina, recent or past myocardial infarction, heart failure, symptomatic arrhythmias, pacemaker and/or history of orthostatic intolerance.
- Document evidence of associated diseases such as peripheral vascular disease, cerebrovascular disease, diabetes mellitus, renal impairment and chronic pulmonary disease.
- Note any recent changes in symptoms in patients with known cardiac disease.
- Document all current medications as well as the use of alcohol and nonprescription drugs.
- Determine the patient’s functional capacity.
Respiratory complications
“Respiratory events are typically related to patients who smoke, have respiratory disease or have sleep apnea,” Ms. Allison says. “Have smokers terminate smoking for 30 days before surgery and delay surgery for symptomatic asthma patients.”
To reduce the risk of adverse events in obstructive sleep apnea (OSA) patients, she says ASCs should do the following:
- Screen patients who show signs that they may have sleep apnea.
- Consider OSA when developing the anesthesia plan of care.
- Develop a protocol to deal with OSA that must be based on evidence-based best practices.
- Use the developed protocol for patients who are diagnosed with OSA and for patients who are not diagnosed but show signs that they may have apnea. The screening process should help the facility staff identify the latter patients.
Bleeding complications
Bleeding is one of the most common reasons patients go to the emergency room after a procedure in an ASC, Ms. Allison says. “Patients need to be identified who use anticoagulants,” she says. “The use of anticoagulant pharmacologic agents includes an inherent risk of increased bleeding, which must be measured against their effectiveness in preventing clot formation.
“Communication with patients to obtain patient information and provide teaching about the peri-operative experience can have a profound impact on the quality of the experience and is key to preventing adverse events in ASCs,” she says.
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