One day surgery selection and preparation of pediatric patients

One day surgery (ODS) has been performed for many years in our pediatric surgical department. In 1975 we began to discharge children the day after surgery, but they were hospitalized one day before to perform preoperative routine laboratory tests and the anesthetic visit. From 1980 to 1984 the tests and the anesthetic visit were performed some days before scheduled surgery in the consulting room. Since 1984 laboratory tests have not been required routinely, but only when justified by clinical evidence of disease [l-3]. Therefore, there has been a very gradual introduction of this practice, which has since gained wide application, and further expansion may be expected. Beside the benefits for children and their families, the increasing demand for minor surgery, and the costs of hospital stay have promoted the natural evolution from ODS to outpatient surgery. This practice is particularly suitable for children, who rarely suffer from systemic diseases and recover earlier after surgery. Furthermore, most surgical procedures in children are simple and require less complicated surgical techniques. In our pediatric surgical department ODS has been applied since 1975, wheareas outpatient surgery (with discharge from the hospital within the same day of surgery) has been adopted more extensively only in the last year. Table 1 shows the procedures commonly performed on an outpatients basis at our department. The anesthetic techniques are based on loco-regional anesthesia combined with sedation or on general intravenous anesthesia. The accurate selection of the patients is a necessary condition to the successful outcome of surgery performed in an outpatient setting [4-71. Other primary factors which we have to consider are the preparation of the parents and the choice of the anesthetic technique, in order to minimize complications which may prevent the discharge from the hospital.