Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. C URRENT O PINION Are morbidly obese patients suitable for ambulatory surgery? Tiffany Sun Moon and Girish P. Joshi Purpose of review The incidence of morbid obesity continues to increase worldwide. Associated comorbidities, particularly obstructive sleep apnea, increase the perioperative morbidity for this group of patients. The purpose of this review is to discuss appropriate selection of morbidly obese patients for ambulatory surgery. Recent findings Patients with BMI <40 kg/m 2 can safely undergo ambulatory surgery, provided their comorbidities are optimized before surgery. However, patients who are super obese (BMI  50 kg/m 2 ) have an increased risk of perioperative complications, suggesting that these patients should be selected with caution for ambulatory surgery. The outcomes data for patients with BMI between 40–50 kg/m 2 are limited, and therefore, it is suggested that other factors such as obstructive sleep apnea are taken into consideration. Summary Recent evidence suggests that carefully selected morbidly obese patients can safely undergo surgery on an ambulatory basis. Individualized evaluations taking into account patient-related factors, surgery-related factors, and anesthesia-related factors should dictate which patients are appropriate for ambulatory surgery. Keywords ambulatory surgery, morbid obesity, obstructive sleep apnea, patient selection INTRODUCTION The number of surgical procedures being performed on an ambulatory basis has increased over the years, as it is associated with decreased cost and superior patient satisfaction [1 & ]. Advances in surgi- cal techniques and anesthetic management have allowed many operations that used to necessitate an overnight stay to be performed on an ambulatory basis [1 & ,2,3 & ]. Selection of patients for ambulatory surgery is critical to ensuring that resources are used efficiently and patients are kept safe. The prevalence of obesity, BMI  30 kg/m 2 , continues to increase worldwide. The largest rate of increase has been in the morbidly obese (BMI  40 kg/m 2 ) and super obese (BMI  50 kg/m 2 ) categories [4]. Obesity is associated with many comorbid conditions, including metabolic syn- drome, hypertension, cardiomyopathy, pulmon- ary hypertension, hypoventilation syndrome, and obstructive sleep apnea (OSA). These comor- bidities can increase perioperative complications. Therefore, appropriate selection of morbidly obese patients for ambulatory surgery remains a contro- versial topic. OUTCOMES AFTER AMBULATORY SURGERY IN THE OBESE The most frequent outcome measures examined when determining appropriate patient selection for ambulatory surgery are perioperative morbidity, unplanned admission, and readmission rates. Obesity has been cited as a risk factor for increased perioperative complications and unanticipated admission after ambulatory surgery [5–7]. However, analysis of a large ambulatory database (i.e., National Survey of Ambulatory Surgery) found that morbidly obese patients had a similar incidence of adverse postoperative outcomes, delayed discharge, and unplanned hospital admission, when compared with nonobese patients [8 && ]. A systematic review of published studies also showed that BMI alone did University of Texas Southwestern Medical Center, Dallas, Texas, USA Correspondence to Girish P. Joshi, MBBS, MD, FFARCSI, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9068, USA. Tel: +1 214 590 7259; fax: +1 214 590 6945; e-mail: girish.joshi@utsouthwestern.edu Curr Opin Anesthesiol 2016, 29:141–145 DOI:10.1097/ACO.0000000000000266 0952-7907 Copyright ß 2016 Wolters Kluwer Health, Inc. All rights reserved. www.co-anesthesiology.com REVIEW