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Purpose <p>To determine whether unhealthy patients undergoing ureteroscopy at an ambulatory surgery center are at high risk of emergency post-operative transfer to an inpatient setting.</p> Methods <p>Records of 100 consecutive high-risk patients undergoing URS at a free-standing ambulatory surgery center (ASC) were reviewed. Patients were considered high-risk if their American Society of Anesthesiologists score (ASA) was ≥ 3. Perioperative risk was assessed using the Charlson Comorbidity Index (CCI) and the 5-factor Modified Frailty Index (mFI-5). Post-operative complications requiring emergent inpatient transfer on the day of surgery and complications within 30-days were recorded.</p> Results <p>The median age for patients was 61.4 years (IQR: 54.7–68.4) and median BMI was 31.0 (IQR: 26.6–37.2). Common chronic illnesses were hypertension (74%), COPD (44%), diabetes (40%), and peripheral vascular disease (14%). All patients were considered high-risk by ASA score. By CCI, 28% of patients were high-risk, 23% were significant risk and 49% were mild risk, with median score of 3 (IQR 1–5). By mFI-5, 20% of patients were high-risk, with median score of 2 (IQR 1–2). No patient required emergent transfer on the day of surgery. Within 30 days postoperatively, 15 patients presented to the Emergency Department (ED) and 5 were admitted. mFI-5 and CCI were not predictive of ED visits.</p> Conclusion <p>Selected high-risk patients with unfavorable ASA, mFI-5, and CCI undergoing URS within an ASC are unlikely to require emergent, post-operative transfer to an inpatient facility.</p>

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Ureteroscopy at ambulatory surgery centers can be safe for select high-risk patients

  • 期刊论文

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  • 发表日期：

    2025年4月22日

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  • Ryan Cook,
  • Andrewe L. Baca,
  • Alexander Small,
  • Carina Himes,
  • Dima Raskolnikov

摘要

Purpose

To determine whether unhealthy patients undergoing ureteroscopy at an ambulatory surgery center are at high risk of emergency post-operative transfer to an inpatient setting.

Methods

Records of 100 consecutive high-risk patients undergoing URS at a free-standing ambulatory surgery center (ASC) were reviewed. Patients were considered high-risk if their American Society of Anesthesiologists score (ASA) was ≥ 3. Perioperative risk was assessed using the Charlson Comorbidity Index (CCI) and the 5-factor Modified Frailty Index (mFI-5). Post-operative complications requiring emergent inpatient transfer on the day of surgery and complications within 30-days were recorded.

Results

The median age for patients was 61.4 years (IQR: 54.7–68.4) and median BMI was 31.0 (IQR: 26.6–37.2). Common chronic illnesses were hypertension (74%), COPD (44%), diabetes (40%), and peripheral vascular disease (14%). All patients were considered high-risk by ASA score. By CCI, 28% of patients were high-risk, 23% were significant risk and 49% were mild risk, with median score of 3 (IQR 1–5). By mFI-5, 20% of patients were high-risk, with median score of 2 (IQR 1–2). No patient required emergent transfer on the day of surgery. Within 30 days postoperatively, 15 patients presented to the Emergency Department (ED) and 5 were admitted. mFI-5 and CCI were not predictive of ED visits.

Conclusion

Selected high-risk patients with unfavorable ASA, mFI-5, and CCI undergoing URS within an ASC are unlikely to require emergent, post-operative transfer to an inpatient facility.