Same-day discharge has become the norm in many aesthetic surgery practices, especially in the ambulatory surgery center (ASC) setting. It’s efficient, cost-effective, and attractive to patients. A recent study in the Aesthetic Surgery Journal reinforces that the push for efficiency in ASCs doesn’t eliminate the need for thorough pre-op workups. If anything, it heightens their importance.
This week, Surgical Aesthetics 411 dives into this research and how it should inform your ASC workflows.
The Numbers Don’t Lie
The team reviewed 2,581 consecutive aesthetic surgery patients treated at a single ASC. Every patient underwent history, physical exam, and bloodwork. Those over 45 received an ECG. The results showed:
- 32.5% had abnormal bloodwork
- 9.3% had abnormal ECGs
- 9.4% of patients required some alteration in care, ranging from iron supplementation to specialist referral
- 1.7% had their surgery delayed or cancelled
Many of these abnormal findings came from patients who appeared completely healthy on history and exam. Supplementary testing, such as bloodwork or ECGs ordered in patients with no obvious risk factors, uncovered the majority of issues.
Why ASCs Raise the Stakes
In a hospital, an unexpected intraoperative event can be buffered by immediate access to labs, imaging, blood products, and medical consults. But ASCs don’t have that safety net. If a complication occurs, you are operating without the same backup, and every decision you make preoperatively is magnified. Regulators also keep a close eye on ASC outcomes. A single serious complication can trigger scrutiny, or worse, loss of accreditation. The margin for error is slim.
What This Means for Your Patients
Consider the common abnormalities that triggered changes in care. Low hemoglobin accounted for most of the pharmaceutical interventions. Detecting iron deficiency before surgery and correcting it is far safer than facing unexpected perioperative anemia. Abnormal ECGs, while less frequent, prompted anesthesiology input and occasionally cardiac workup. That is precisely the type of risk you don’t want to uncover on the table.
Pregnancy detection is another critical takeaway. Fifteen patients had surgery postponed after testing positive for hCG. Identifying this on pre-op bloodwork rather than the morning of surgery avoids wasted OR time and prevents the catastrophic risk of operating unknowingly on a pregnant patient.
The “Choosing Wisely” Dilemma
Guidelines in both Canada and the US have argued against routine pre-op testing for low-risk surgery. That philosophy works in resource-rich hospital systems. But aesthetic surgery in an ASC isn’t the same as low-risk hernia repair in a hospital setting. The absence of immediate backup means you can’t afford to gamble on what a “healthy” patient might be hiding. In this study, nearly 90 patients (3.4% of the total cohort) required meaningful care changes based solely on tests that guidelines would consider unnecessary.
How to Integrate This Into Your Practice
- Keep testing protocols robust. Bloodwork and ECGs may feel redundant for younger, healthy patients, but the data supports their value in ASC practice.
- Tailor by risk profile. Patients over 50, women, those with higher ASA class, and those with comorbidities were most likely to need changes in care. Consider lowering your threshold for additional testing in these groups.
- Make pregnancy testing two-stage. Combining pre-op bloodwork with same-day urine testing helps reduce the chance of missed pregnancies and minimizes OR disruption.
- Use findings to optimize, not just exclude. Many alterations in care were proactive optimizations (iron therapy, VTE prophylaxis, medication adjustments) that likely reduced downstream complications.
Bottom Line
The efficiency of the ASC model only works if patient safety is uncompromised. This study makes it clear that routine pre-op workups can be critical safeguards. Even if only a minority of patients benefit, those interventions may prevent avoidable complications that can jeopardize both patient outcomes and your practice’s standing.
SOURCES: Aesthetic Surgery Journal
This content is intended for educational purposes only and does not substitute for clinical judgment. Treatment decisions should be based on individual patient needs, professional guidelines, and a comprehensive clinical evaluation.
