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PEDIATRICS

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and/or medical director for their appropriateness for treatment at procedures and the growing emphasis on decreasing the cost of
an ASC (table 2) as they have a higher rate of need for admission healthcare in the United States, ambulatory surgical centers are here
to a hospital/overnight observation (6). to stay. In the pediatric population, the last decade has seen a 40 per-
cent increase in ambulatory cases. As this trend is sure to continue,
Hospital Transfers more data and analysis with regards to quality and cost at ambulatory
As with any surgical procedure or anesthetic exposure, there are surgical centers will certainly emerge. From the parent’s perspective,
risks that range from minor injuries to critical illness. Case appro- the question of whether or not their child is safe is paramount. Based
priateness and patient selection minimize the exposure of the pa- on the information available today, the answer is ‘it depends.’ For the
tient and the ASC to the latter, however, if enough cases are appropriate surgery in the appropriate patient, ambulatory surgical cen-
performed there will inevitably be the need to transfer a patient to ters are an excellent alternative to hospital-based surgeries that can cut
a hospital. ASCs have in place protocols and hospital affiliations health care costs, facilitate earlier scheduling, and provide an ideal en-
that would facilitate a safe transfer of care, but such an occurrence vironment for surgeons to operate. As the success of ambulatory sur-
can be a significant burden to the patient and family in many ways, gical centers depend on efficiency and quality of care, parents can be
including financial. assured that there will be measures in place to keep their child safe and
avoid delays/cancellations. As the parent of a child scheduled for sur-
Preparation gery at a surgical center it is important to always ask questions, com-
Anecdotally, in my practice the most common reasons for can- municate changes to a child’s health, accurately report health history
cellation are NPO status and failure to report or identify a change and follow the guidelines set forth by the surgery center to ensure a
in health status. safe and smooth surgical experience.
NPO refers to fasting practices prior to surgery. Based on the
American Society of Anesthesiology, fasting recommendations About the Author:
(NPO guidelines) are as follows: Dr. Michael Kim is an anesthesiologist working in private prac-
Clear liquids no sooner than 2 hours prior to surgery • Breast tice with a San Antonio-based anesthesia group, Tejas Anesthesia
milk 4 hours • Infant formula 6 hours • Nonhuman milk 6 hours • PA. He obtained his medical degree from Boston University and
Light meal 6 hours • Fried foods, fatty foods, or meat - additional completed his training at Boston Medical Center. He is board cer-
fasting time (e.g., 8 or more hours) may be needed (7). tified in Anesthesiology.
In terms of recent health changes, upper respiratory infections
tend to be the most common reason for cancellation. It would be Works Cited:
prudent for parents to report to the surgeon or the ASC any recent 1. Pregler, J. L., & Kapur, P. A. (2003). The development of ambulatory anesthesia
and future challenges. Anesthesiology Clinics of North America,21(2), 207-228.
upper respiratory infection type symptoms including: cough, runny doi:10.1016/s0889-8537(02)00073-1
nose, yellow/green/brown sputum or drainage, change in energy 2. Rabbitts, J. A., Groenewald, C. B., Moriarty, J. P., & Flick, R. (2010). Epidemiology
of Ambulatory Anesthesia for Children in the United States: 2006 and 1996.
level, fevers, chills, sweats. Anesthesia & Analgesia,1. doi:10.1213/ane.0b013e3181ee8479
Keep in mind that if your child is cancelled on the day of surgery, 3. Whippey, A., Kostandoff, G., Ma, H.K., Cheng, J., Thabane,, L., & Paul, J. (2016).
Predictors of unanticipated admission following ambulatory surgery in the pe-
it is for the health and safety of your child first and foremost. diatric population: A retrospective case-control study. Pediatric Anesthesia,
Financially speaking, cancellations on the day of surgery are a 26(8),8310837.doi:10.1111/pan.12937
4. Study: Medicare Cost Savings Tied to ASCs. (n.d.). Retrieved from
tremendous cost to hospitals and ASCs alike so it is in their financial http://www.ascassociation.org/advancingsurgicalcare/reducinghealthcarecosts/c
interest to minimize cancellations. A study out of Tulane estimated ostsavings/medicarecostsavingstiedtoascs
5. Federal Requirements Governing ASCs. (n.d.). Retrieved from https://www.as-
that at their institution, case cancellations for pediatric cases cost
cassociation.org/advancingsurgicalcare/safetyquality/federalrequirementsgov-
the hospital an estimated $5,697 per case cancelled. This figure is erningascs
likely to be significantly less in the Ambulatory Surgical Center, but 6. ASA Physical Status Classification System - American Society of Anesthesiolo-
gists (ASA). (n.d.). Retrieved from https://www.asahq.org/resources/clinical-in-
still significant (8). That is to say that if your child is scheduled for formation/asa-physical-status-classification-system
surgery at an ASC, you can expect that there will be layers of forms, 7. Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic
Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Pa-
documents and phone calls to ensure that he/she is a good candi- tients Undergoing Elective Procedures:An Updated Report by the American So-
date and is adequately prepared for a safe and efficient experience. ciety of Anesthesiologists Committee on Standards and Practice Parameters.
(2011, March 01). Retrieved from http://anesthesiology.pubs.asahq.org/
Article.aspx?articleid=1933410
Summary 8. Campbell, C, Mora, A, Perniciaro, S, Abdur-Rahman, N, Pierre, N, Rosinia, F,
With surgical advancements decreasing the morbidity of surgical Bent, S. 2011/01/01 The Financial Burden of Cancelled Surgeries: Implications
for Performance Improvement.

16 San Antonio Medicine • June 2018