BMI 60 for shoulder scope is a hypothetical. Not okay by anyone’s standard in a freestanding ASC (I assume….) yet they go to the hospital, get the same anesthesia, and go home same day most of the time.
Some people on this board are treating hospital transfers like a patient death. They happen. And often they are not a big deal.
Obviously the goal is not to transfer. But if you do enough cases of decent size you will inevitably get transfers. For pain control, arrythmia, unable to wean O2, no one to help with care at home, those are pretty much the big ones.
If you were the surgical center admin, would you rather:
A: 25k cases per year, 4 hospital transfers
B: 10k cases per year and 1 hospital transfer
The badness comes when you can predict the transfer but do the case anyways.
A BMI 60 is more likely to need post op o2 weaning., sat monitoring.
An EF 25% is more likely to need post op pressors, BP checks
A big surgery that is likely to require blood, and the patient ends up hypotensive and you have to transfer to give blood
An elderly patient with dementia and poor home care..
Those are egg on your face. You knew it would LIKELY be a problem, but did the case anyways and dumped it on the hospital.
That's to the detriment of the surgeon and to the patient.
I often think, will this look bad if i end up having to transfer this person? Unless you have done a case in the face of a major red flag, NO.
This discussion reminds me a little of a pre-op nurse who tries to get me to cancel patients with an elevated HgA1c. Yes, I get that they are not healthy, but no acute reason to cancel...
And BTW there are lots of patients who prefer to have their case done at the ASC and not deal with the many issues surrounding going to the hospital, so its not as if its only done for the money. Im sure when the LMA came out there were lots of dug-in docs saying how unsafe it was, the future is in ASCs and outside of the hospital for more and more cases so we have to get on board