To the Editor.
—Dr Warner and colleagues1 present an excellent study to demonstrate the safety of ambulatory surgery and anesthesia. I would disagree, however, with the "well-known observation that patients scheduled for elective surgical procedures are usually healthier than the general population." In their study, 24% (10 867/45 090) of procedures were performed on patients of American Society of Anesthesiologists physical status (ASA PS) classification 3, with "severe systemic disease, definite functional limitation." I would be surprised if this sample of the population was healthier than the age-adjusted general population in the area. Perhaps some data are available to compare the prevalence of hypertension and diabetes in the study patients with the general population.According to Orkin and Gold,2 "[W]hen there was a need to gain credibility with both the medical community and the insurance industry, only the healthiest were deemed appropriate candidates. With the passage of time
Feldman M, Pasternak R, Paul S. Morbidity and Mortality After Ambulatory Surgery. JAMA. 1994;271(11):823. doi:10.1001/jama.1994.03510350031022