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 identif ied the pattern of home-readiness, the persistent symptoms after surge ry, and the factors that delay discharge after home-readiness criteria are satisfied. Five hundred patients were scored by the same investig ator using the Postanesthetic Discharge Scoring System (PADSS) every 3 0 min, commencing 30 min after surgery, until the PADSS score was grea ter than or equal to 9. The same investigator telephoned each patient 24 h after discharge to administer a standardized questionnaire so tha t postoperative symptoms could be identified. Eighty-two percent of pa tients were discharged 2 h and 95.6% 3 h after surgery. These patients could have been discharged earlier. After home-readiness criteria wer e satisfied, some patients had delayed discharge because of the unavai lability of immediate escorts or the recurrence of pain. Persistent sy mptoms delaying discharge occurred in 4.4% of patients. Patients who u nderwent certain ambulatory surgical procedures, such as laparoscopy o r orthopedic and general surgery, had a sixfold increased risk of deve loping persistent symptoms in the ambulatory surgery unit. The time to home-readiness was 2.5-fold longer and the incidence of 24-h postoper ative symptoms, two- to eightfold higher in the group with persistent symptoms in the ambulatory surgery unit. In summary, periodic objectiv e 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 ty pe of surgery. Most delays after satisfactory home-readiness scores we re reached were due to nonmedical reasons. Patients with persistent po stoperative symptoms in the ambulatory surgery unit correlated with in creased 24-h postoperative symptoms.