Peer-reviewed article
Perspectives in Pediatric Ambulatory Anesthesia: Part 1-One Center's 15 Year Evolution in Eligibility, Utilization, Efficiency, and Outcomes.
Low AB, Chiem JL, Casey C, Vanderhoek SM, Martin LD ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This is a clinical study of ambulatory anesthesia practices at a pediatric surgery center over 15 years, tracking how eligibility criteria, patient complexity, and operational efficiency changed over time. The authors found that the center successfully managed increasing patient acuity without increased complications. The study is limited to one academic pediatric facility and does not address child well-being outcomes relevant to the African Institute for Children Studies.
Key points
- Patient acuity increased over 15 years, with lower age cutoffs and higher ASA physical status scores accepted
- No increase in unplanned emergency visits or hospital admissions despite higher acuity
- COVID-19 pandemic temporarily closed the facility and altered case mix
- Results are specific to an academic pediatric center and not generalizable to community facilities
Limitations
This is a single-center operational study focused on procedural and administrative metrics in a specialized academic setting, not on child health outcomes or well-being. The findings cannot inform child well-being research or policy in low- or middle-income settings.
Abstract
Introduction Ambulatory surgery has become the dominant model of surgical care in the United States as surgical procedures increasingly shifted from inpatient to outpatient sites of practice. Similar growth in volumes has been observed in pediatric practice. Investigators have highlighted the challenges and opportunities in this current climate, including increasing medical and procedural complexity, difficulties matching pediatric-specific resources to meet the child's perioperative needs and unique risk profile, and limited availability of pediatric ambulatory surgical and anesthesia guidelines of care. Further, they call out the complete lack of pediatric outcomes data to help inform the creation and modification of national care guidelines. Methods To address these challenges, we chose to complete a comprehensive, single center retrospective review of our process, outcome, and balancing metrics contained in our EMR from our free-standing pediatric ambulatory surgery center (ASC) since its opening in July 2010 through December 2024. A commercial software system extracted de-identified, aggregated health data from the system's EMR. The data are processed and presented in statistical process control charts. This methodology allows clinicians to distinguish between common cause and special cause variation. Results Patient and procedural acuity increased as the system matured via lower age cutoffs and higher ASA physical status scores. This higher acuity was managed with a dynamic and evolving screening process, resulting in no change in unplanned emergency visit or hospital admissions. The COVID-19 pandemic had profound impacts on ASC operations and case mix, including a temporary closure. Discussion This retrospective, observational assessment created a detailed picture of our ASC practice changes over time. A pediatric-specific ASC with appropriate patient selection processes, practice guidelines, and clinical expertise successfully mitigated the risk of complications. These results are not generalizable to non-academic, community ambulatory facilities due to the unique characteristics of our pediatric-specific academic center.