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December 25, 1991

Outpatient Surgery: Boom or Doom?

Author Affiliations

University of Illinois at Chicago College of Medicine

University of Illinois at Chicago College of Medicine

JAMA. 1991;266(24):3426. doi:10.1001/jama.1991.03470240048029

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To the Editor.  — Outpatient or ambulatory surgery results in large savings in health care costs—a big "boom" in reducing the per capita cost. If well managed, the risks of outpatient surgery are not greater than inpatient procedures. The sine qua non of a safe ambulatory surgical center is that the surgical and anesthesia care is equal to or surpasses that available for inpatients.However, one frequently encounters patients preoperatively who are extremely anxious, since these outpatients received no preanesthetic medication on the morning of surgery. A large number of patients report that they have slept less than usual, and an occasional patient reports an attack of anxiety during the night.A hypnotic agent given the night before and an antianxiety drug given on the morning of surgery may help to maintain normal diurnal cortisol levels, and an antianxiety agent reduces the abnormal increase in cortisol levels before and during