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Davila VR, Saklayen S, Tang J. Cardiovascular procedures in ambulatory cardiac procedures: really? Curr Opin Anaesthesiol 2024:00001503-990000000-00232. [PMID: 39352273 DOI: 10.1097/aco.0000000000001435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2024]
Abstract
PURPOSE OF REVIEW To evaluate the current trends, safety, and feasibility of same-day discharge (SDD) in ambulatory cardiac procedures, with a focus on percutaneous coronary interventions (PCI). This review also discusses the impact of technological advancements and explores future directions for expanding the scope of SDD in more complex cardiac procedures. RECENT FINDINGS Recent studies have demonstrated that SDD after PCI is both well tolerated and effective for appropriately selected patients, with outcomes comparable with those of patients who remain hospitalized overnight. Advancements in PCI technology, including improved stent designs, smaller sheath sizes, and the adoption of the transradial approach, have significantly enhanced the feasibility of SDD. Enhanced recovery after surgery (ERAS) pathways, adapted for ambulatory settings, further improve patient safety, particularly as more complex procedures are attempted. However, challenges remain in determining SDD eligibility, particularly in settings with limited emergency care capabilities. SUMMARY SDD is a viable and cost-effective option for low-risk patients undergoing PCI and other ambulatory cardiac procedures. The successful implementation of SDD requires careful patient selection, adherence to standardized protocols, and vigilant postprocedural monitoring. Future research should focus on refining patient selection tools, expanding the scope of SDD to include more complex procedures, and enhancing postdischarge monitoring through advanced technologies. Multidisciplinary collaboration and ongoing education are essential to support the well tolerated and effective adoption of SDD in ambulatory cardiac care.
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Affiliation(s)
- Victor R Davila
- Ohio State University Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Rosero EB, Rajan N, Joshi GP. Pro-Con Debate: Are Patients With Coronary Stents Suitable for Free-Standing Ambulatory Surgery Centers? Anesth Analg 2023; 136:218-226. [PMID: 36638505 DOI: 10.1213/ane.0000000000006237] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
With increasing implantation of coronary artery stents over the past 2 decades, it is inevitable that anesthesiologists practicing in the outpatient setting will need to determine whether these patients are suitable for procedures at a free-standing ambulatory surgery center (ASC). Appropriate selection of patients with coronary artery stents for a procedure in an ASC requires consideration of factors that affect the balance between the risk of stent thrombosis due to interruption of antiplatelet therapy and the thrombogenic effects of surgery, and the risk of perioperative bleeding complications that may occur if antiplatelet therapy is continued. Thus, periprocedure care of these patients presents unique challenges, particularly for extensive surgical procedures that are increasingly scheduled for free-standing ASCs, where consultation and ancillary services, as well as access to percutaneous cardiac interventions, may not be readily available. Therefore, the suitability of the ambulatory setting for this patient population remains highly controversial. In this Pro-Con commentary, we discuss the arguments for and against scheduling patients with coronary artery stents in free-standing ASCs.
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Affiliation(s)
- Eric B Rosero
- From the Department of Anesthesiology and Pain Management, University of Texas Southwestern, Dallas, Texas
| | - Niraja Rajan
- Department of Anesthesiology and Perioperative Medicine, Penn State Health, Hershey, Pennsylvania
| | - Girish P Joshi
- From the Department of Anesthesiology and Pain Management, University of Texas Southwestern, Dallas, Texas
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Fellahi JL, Godier A, Benchetrit D, Berthier F, Besch G, Bochaton T, Bonnefoy-Cudraz E, Coriat P, Gayat E, Hong A, Jenck S, Le Gall A, Longrois D, Martin AC, Pili-Floury S, Piriou V, Provenchère S, Rozec B, Samain E, Schweizer R, Billard V. Perioperative management of patients with coronary artery disease undergoing non-cardiac surgery: Summary from the French Society of Anaesthesia and Intensive Care Medicine 2017 convention. Anaesth Crit Care Pain Med 2018; 37:367-374. [PMID: 29567130 DOI: 10.1016/j.accpm.2018.02.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 02/09/2018] [Accepted: 02/26/2018] [Indexed: 12/19/2022]
Abstract
This review summarises the specific stakes of preoperative, intraoperative, and postoperative periods of patients with coronary artery disease undergoing non-cardiac surgery. All practitioners involved in the perioperative management of such high cardiac risk patients should be aware of the modern concepts expected to decrease major adverse cardiac events and improve short- and long-term outcomes. A multidisciplinary approach via a functional heart team including anaesthesiologists, cardiologists and surgeons must be encouraged. Rational and algorithm-guided management of those patients should be known and implemented from preoperative to postoperative period.
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Affiliation(s)
- Jean-Luc Fellahi
- Department of anaesthesia and intensive care, Louis-Pradel hospital, hospices civils de Lyon, 59, boulevard Pinel, 69394 Lyon cedex 03, France.
| | - Anne Godier
- Department of anaesthesia and intensive care, fondation Adolphe-de-Rothschild, 75019 Paris, France
| | - Deborah Benchetrit
- Department of anaesthesia and intensive care, Pitié-Salpêtrière university hospital, Paris, France
| | - Francis Berthier
- Department of anaesthesia and intensive care, Besançon university hospital, Besançon, France
| | - Guillaume Besch
- Department of anaesthesia and intensive care, Besançon university hospital, Besançon, France
| | - Thomas Bochaton
- Intensive care and cardiological emergencies, Louis-Pradel hospital, hospices civils de Lyon, Lyon, France
| | - Eric Bonnefoy-Cudraz
- Intensive care and cardiological emergencies, Louis-Pradel hospital, hospices civils de Lyon, Lyon, France
| | - Pierre Coriat
- Department of anaesthesia and intensive care, Pitié-Salpêtrière university hospital, Paris, France
| | - Etienne Gayat
- Department of anaesthesia ans intensive care, Saint-Louis-Lariboisière-Fernand-Widal university hospitals, Paris, France
| | - Alex Hong
- Department of anaesthesia ans intensive care, Saint-Louis-Lariboisière-Fernand-Widal university hospitals, Paris, France
| | - Sophie Jenck
- Intensive care and cardiological emergencies, Louis-Pradel hospital, hospices civils de Lyon, Lyon, France
| | - Arthur Le Gall
- Department of anaesthesia ans intensive care, Saint-Louis-Lariboisière-Fernand-Widal university hospitals, Paris, France
| | - Dan Longrois
- Department of anaesthesia and intensive care, Bichat-Claude-Bernard hospital, Paris, France
| | | | - Sébastien Pili-Floury
- Department of anaesthesia and intensive care, Besançon university hospital, Besançon, France
| | - Vincent Piriou
- Department of anaesthesia and intensive care, hospices civils de Lyon, Lyon-sud hospital, Lyon, France
| | - Sophie Provenchère
- Department of anaesthesia and intensive care, Bichat-Claude-Bernard hospital, Paris, France
| | - Bertrand Rozec
- Department of anaesthesia and intensive care, Nantes university hospital, Nantes, France
| | - Emmanuel Samain
- Department of anaesthesia and intensive care, Besançon university hospital, Besançon, France
| | - Rémi Schweizer
- Department of anaesthesia and intensive care, Louis-Pradel hospital, hospices civils de Lyon, 59, boulevard Pinel, 69394 Lyon cedex 03, France
| | - Valérie Billard
- Department of anaesthesia, institut Gustave-Roussy, Villejuif, France
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Wu J, Normand K, Medina-Rivera G. Anesthesia Emergencies in the Ambulatory Setting. CURRENT ANESTHESIOLOGY REPORTS 2016. [DOI: 10.1007/s40140-016-0182-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Shaw D, Ternent CA. Perioperative Management of the Ambulatory Anorectal Surgery Patient. Clin Colon Rectal Surg 2016; 29:7-13. [PMID: 26929746 PMCID: PMC4755778 DOI: 10.1055/s-0035-1570023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Ambulatory surgery is appropriate for most anorectal pathology. Ambulatory anorectal surgery can be performed at reduced cost compared with inpatient procedures with excellent safety, improved efficiency, and high levels of patient satisfaction. Several perioperative strategies are employed to control pain and avoid urinary retention, including the use of a multimodal pain regimen and restriction of intravenous fluids. Ambulatory anorectal surgery often utilizes standardized order sets and discharge instructions.
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Affiliation(s)
- Darcy Shaw
- Colon and Rectal Surgery Inc., Omaha, Nebraska
| | - Charles A. Ternent
- Department of Surgery, Section of Colon and Rectal Surgery, Creighton University School of Medicine, Omaha, Nebraska
- Department of Surgery, Department of Surgery, University of Nebraska College of Medicine, Omaha, Nebraska
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