Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. Outcomes in day surgery Ilia Shnaider and Frances Chung Purpose of review To summarize and examine the updated published results on the outcome measures that can be used to assess the quality of ambulatory surgery and anesthesia. Recent findings Major morbidity and mortality following ambulatory surgery is exceedingly low. Cancellations and delays may have a negative impact on the patients, healthcare personnel and the organizations. Minor cardiovascular adverse events are the most common intraoperatively and are associated with preexisting cardiovascular diseases and elderly patients. Respiratory events postoperatively are associated with obesity, smoking and asthma. Also, pain is a common cause for longer postoperative stay, unanticipated admission and readmission. Postoperative nausea and vomiting occurs in 30% of patients and strongly affects patient satisfaction. Furthermore, prolonged stays are mainly caused by surgical factors, or minor symptoms like pain or nausea. Surgical factors are also the main causes of unanticipated hospital admission. The type of surgery and the 24 h postoperative symptoms may affect the degree of return to daily living function. Also, patient satisfaction affects the outcome of healthcare and the use of healthcare services. Summary Ambulatory surgery, as currently practiced, provides quality care that is cost-effective. Minor adverse events such as pain and postoperative nausea and vomiting are still common, and improvement could be targeted in these areas. Keywords adverse outcomes, ambulatory anesthesia, ambulatory surgery, nausea and vomiting, pain, quality improvement, readmissions Curr Opin Anaesthesiol 19:622–629. ß 2006 Lippincott Williams & Wilkins. Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada Correspondence to Dr Frances Chung, Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, McL 2-405, 399 Bathurst St., Toronto, Ontario, Canada M5T 2S8 Tel: +1 416 603 5118; fax: +1 416 603 6494; e-mail: frances.chung@uhn.on.ca Current Opinion in Anaesthesiology 2006, 19:622–629 Abbreviations ASA American Society of Anesthesiologists ENT ear–nose–throat PONV postoperative nausea and vomiting ß 2006 Lippincott Williams & Wilkins 0952-7907 Introduction One of the most significant changes in surgical practice over the past two decades has been the change in emphasis from inpatient to ambulatory surgical care. Advances in surgical and anesthetic techniques were a prerequisite for this tremendous growth in ambulatory surgery worldwide. The continued improvement in anesthesia techniques, such as regional anesthesia, ultra-short acting drugs with minimal side effects, more relevant ambulatory discharge criteria, and minimal inva- sive surgery techniques will allow larger numbers of patients to take advantage of ambulatory surgery [1,2]. Ambulatory surgery allows earlier return to preoperative physiological state, fewer complications, reduced mental and physical disability, and early resumption of normal activities. Hospital costs are lower because ambulatory surgery is more efficient than inpatient care. The rapid growth in ambulatory surgery has resulted in the need for healthcare personnel and organizations to find an objective way to measure the quality of care provided. The assessment should include monitoring the clinical process of care and measurement of patient-assessed outcomes. These outcomes may be used to set standards of practice. Quality Quality management is essential to the practice of anesthesia. Industrial quality measurement such as qual- ity control, quality management, and continuous quality improvement have been introduced into the healthcare and anesthesia area [3]. The Concise Oxford Dictionary defines quality as ‘possessing a high degree of excel- lence’. Donabenian [4] defines the quality of medicine as ‘that kind of care which is expected to maximize an inclusive measure of patient welfare, after one has taken account of the balance of expected gains and losses that attend the process of care in all parts’. Quality may be defined in a different way by each observer: the healthcare system, anesthesiologists, sur- geons and patients, and according to Duncan [5], it should satisfy all of them. In hospitals, quality has been defined by seven attributes requiring assessment by all departments including anesthesia. These attributes are safety, provider competence, acceptability, accessibility, efficiency, appropriateness, and effectiveness [6]. For the surgeon, the measure of quality in anesthesia is often reflected in the factors that contribute to the facilitation 622