Anesthetic and perioperative management of patient for breast reconstruction in an outpatient clinic

BACKGROUND: Our clinic provides various reconstructive surgeries but does not have facilities for patient admission, but there is a hospital providing satisfactory post-operative treatments in our area. METHODS: During the past 3 years, 276 patients received reconstructive mammoplasty under general anesthesia at our clinic. Their post-operative conditions immediately after the recovery were evaluated with the Modified Post-Anesthesia Discharge Scoring System (MPADSS). After observation for 4 to 5 hours in a recovery room, all the patients were transferred to another hospital by car. RESULTS: The score was 9 or 10 points in 45% of the patients. This indicates that the patients can be transferred to another hospital without problems. Twenty percent of patients had 6-7 points. These patients had mild bleeding, pain and/or unsteadiness/nausea/vomiting while walking. Among the 256 patients who were transferred to another hospital by car, one patient vomited in the car and 5 patients had nausea after the transfer. The other 20 patients whose score was 7 or lower were transferred by special vehicle with a stretcher and their conditions did not aggravate at all. CONCLUSIONS: At present, it is dangerous to perform all breast reconstructive surgeries as a day surgeries. A system is indispensable in which patients are transferred after surgery to another hospital with over-night stay facilities enabling observation.