Preoperative Considerations for Ambulatory Surgery: What Is New, What Is Controversial

Ambulatory anesthesia has experienced a rapid expansion in procedural breadth and patient complexity. Proper patient selection via preoperative evaluation and testing is imperative to ensure the safety of patients with major comorbidities and advanced age who undergo procedures in ambulatory surgical settings. New developments and controversies have arisen in the preoperative considerations for ambulatory surgical patients with class III obesity, obstructive sleep apnea, pulmonary hypertension, cardiomyopathy, heart failure, and other severe diseases. The value of preoperative laboratory testing is also debated. There are controversies and new developments with important implications for current and future practice in ambulatory anesthesia. With careful preoperative evaluation, testing, and patient selection process, patients with severe diseases may safely undergo ambulatory surgery. Individualized evaluations should dictate which patients are appropriate for ambulatory surgery.