Same day surgery (SDS), also known as ambulatory or outpatient surgery, is a common standard of modern medical care. This approach minimizes the time a patient spends in a hospital setting, focusing on efficiency and a rapid return home. Understanding the definition, selection process, and operational flow is helpful for anyone considering this type of procedure.
Defining Same Day Surgery
Same day surgery (SDS) refers to a planned procedure where the patient is admitted, undergoes the operation, recovers from anesthesia, and is discharged home all within the same calendar day. This model is also called day surgery or ambulatory surgery, and it is distinct from inpatient surgery, which requires an overnight stay. Although some definitions allow for a stay of up to 23 hours, the primary goal is discharge on the same working day.
The elimination of the overnight hospitalization period is the fundamental difference from traditional inpatient care. This is possible due to advancements in minimally invasive surgical techniques and the use of shorter-acting anesthetics. The result is reduced healthcare costs, a lower risk of hospital-acquired infections, and a more comfortable recovery at home.
Patient Selection Criteria
The selection process for same day surgery is rigorous, ensuring only appropriate patients are scheduled for this rapid discharge model. A major factor is the patient’s general health, assessed using the American Society of Anesthesiologists (ASA) physical status classification system. Patients classified as ASA 1 (healthy) or ASA 2 (mild, well-controlled systemic disease) are generally considered ideal candidates.
Patients classified as ASA 4 (severe, life-threatening systemic diseases) are not suitable due to the increased risk of complications. However, ASA 3 patients (severe but non-life-threatening systemic disease) may be considered if their condition is stable. The procedure itself must be low-risk, involving minimal expected blood loss and a low need for complex post-operative pain management.
The patient’s home environment is also a significant factor. Discharge requires the patient to have a responsible adult caregiver available to accompany them home and remain with them for the first 24 hours after the procedure. This caregiver must be able to assist with basic needs and monitor for complications. Patients must also have safe transportation home after the procedure.
The Operational Flow
The patient journey begins with mandatory pre-operative instructions, most commonly involving fasting (NPO status) to prevent anesthesia complications. Upon arrival at the facility, the patient checks in and is taken to a pre-operative area for preparation. A nurse performs a physical assessment, and the surgeon and anesthesia provider confirm the plan and mark the surgical site.
The patient is moved to the operating room for the procedure, which uses modern techniques designed for rapid recovery. Immediately following the surgery, the patient is transferred to the Post-Anesthesia Care Unit (PACU), also called the recovery room, for intensive monitoring. PACU nurses closely track vital signs, which must return to near the patient’s pre-operative baseline.
The PACU stay length is determined by how quickly the patient meets specific discharge criteria, often involving a scoring system like the Modified Aldrete Score or the Postanesthesia Discharge Scoring System (PADS). Patients must demonstrate stable vital signs, minimal pain controllable with oral medication, and controlled nausea or vomiting. They must also be alert, oriented, and able to ambulate with assistance before being cleared for discharge.
Once cleared, the patient moves to a final discharge area where the accompanying adult caregiver receives detailed verbal and written instructions. These instructions cover wound care, necessary prescriptions, and contact numbers for emergencies. The care team contacts the patient the following day to check on their well-being, completing the same day surgery process.