Ambulatory surgery : Is there an age limit ?

Ambulatory surgery means taking charge of patients in a short, continuous and careful manner allowing a safe and quick return back to a usual and reassuring living environment. Concerning elderly people, this way of proceeding can be considered as a real advantage: less disorientation, less cognitive dysfunction and postoperative delirium, less adverse effects by minimizing risks of hypoxia, hypovolemia and hypothermia, less nosocomial infections. In order not to jeopardize these benefits, some specific conditions must be met. Patient’s selection for ambulatory surgery must be strict as well as realistic. Perioperative management must not lead to a destabilization of patient’s medical status already made vulnerable by impaired physiological capacities. Special attention must be dedicated to the prevention of cognitive dysfunction and postoperative delirium, also than to uncontrolled post-operative pain. The two periods before and especially after patient’s admission must also be managed very carefully. An appropriate, well informed and quick to react accompanying person is therefore essential. In the future, mini invasive and/or robotic surgery, telemedicine and the use of liposomal local anaesthetics may allow more elderly patients to take a real advantage of ambulatory surgery.