Postoperative Discharge Scoring Criteria After Outpatient Anesthesia: A Review of the Literature

Published:January 18, 2023DOI:



      The aim of this review was to explore the existing literature on discharge criteria, tools and strategies used in the postanesthesia care unit (PACU) after ambulatory surgery and to identify the essential components of an effective and feasible scoring system based on applicable criteria for the three phases of anesthesia recovery to assess patient discharge after outpatient anaesthesia.


      A review of the literature.


      In this study, a review of sixteen articles was conducted to analyze the affecting factors, evaluation tools, and the current research status of patients discharge after outpatient anesthesia.


      The main factors affecting the discharge after diagnostic or therapeutic procedures under outpatient anesthesia were hospital management, medical treatment and patients themselves. Physiological systems-based discharge assessment had several advantages over traditional time-based discharge assessment. The Aldrete scoring scale was often used for patients in the first stage of anesthesia recovery to leave the PACU, and the Chung's scoring scale was often used to evaluate patients in the second stage of recovery until they leave the hospital. These two scales were often used in combination for outpatient anesthesia. The Fast-tracking assessment tool was used in patients who directly returned to the ward or discharge of patients after ambulatory surgery. There is currently no uniform standard or tool for assessing patients discharge after diagnostic or therapeutic procedures under the outpatient anesthesia.


      Optimal care under anesthesia should allow the patient to recover from anesthesia smoothly and quickly and leave the hospital safely. When the patients can safely leave the hospital after outpatient anesthesia is still a problem that needs to be solved in the nursing field. Various existing scoring systems have their historical advancements, but we need to formulate more in line with the current status of postoperative patients discharge standards.

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        • Zalzal HG
        • Makary CA
        • Evans R
        • et al.
        Using clinical indicators to reduce perianesthesia recovery time following outpatient tonsillectomy.
        Ann Otol Rhinol Laryngol. 2018; 127: 620-624
        • Cai XZ QF
        • F ZH
        • Zhou PH WP
        Discharge following endoscopic sedation procedures: an implementation of an evidence-based protocol.
        Chinese J Practical Nursing. 2019; 35 (【Article in Chinese】): 1869-1872
        • Poves-Álvarez R
        • Gómez-Sánchez E
        • Martínez-Rafael B
        • et al.
        Parental satisfaction with autonomous pediatric ambulatory surgery units.
        Qual Manag Health Care. 2021; 30: 145-152
        • Armstrong J
        • Forrest H
        • Crawford MW.
        A prospective observational study comparing a physiological scoring system with time-based discharge criteria in pediatric ambulatory surgical patients.
        Can J Anaesth. 2015; 62: 1082-1088
        • Okocha O
        • Gerlach RM
        • Sweitzer B.
        Preoperative evaluation for ambulatory anesthesia: what, when, and how.
        Anesthesiol Clin. 2019; 37: 195-213
        • Youn AM
        • Ko YK
        • Kim YH.
        Anesthesia and sedation outside of the operating room.
        Korean J Anesthesiol. 2015; 68: 323-331
        • Rajan N
        • Rosero EB
        • Joshi GP.
        Patient selection for adult ambulatory surgery: a narrative review.
        Anesth Analg. 2021; 133: 1415-1430
      1. Heitz JW. Post-Anesthesia Care:Symptoms, Diagnosis, and Management. Post-Anesthesia Care Unit, Thomas Jefferson University Hospital, Philadelphia, PA, USA.

        • Hawker RJ
        • McKillop A
        • Jacobs S.
        Postanesthesia scoring methods: an integrative review of the literature.
        J Perianesth Nurs. 2017; 32: 557-572
        • Tang CL
        • Li J
        • Zhang ZT
        • et al.
        Neuroprotective effect of bispectral index-guided fast-track anesthesia using sevoflurane combined with dexmedetomidine for intracranial aneurysm embolization.
        Neural Regen Res. 2018; 13: 280-288
        • Rice AN
        • Muckler VC
        • Miller WR
        • Vacchiano CA.
        Fast-tracking ambulatory surgery patients following anesthesia.
        J Perianesth Nurs. 2015; 30: 124-133
        • Mathew M
        • Ragsdale TD
        • Pharr ZK
        • Rider CM
        • Mihalko WM
        • Toy PC.
        Risk factors for prolonged time to discharge in total Hip patients performed in an ambulatory surgery center due to complaints of the inability to void.
        J Arthroplasty. 2021; 36: 3681-3685
        • Watt J
        • Tricco AC
        • Talbot-Hamon C
        • et al.
        Identifying older adults at risk of harm following elective surgery: a systematic review and meta-analysis.
        BMC Med. 2018; 16:2
        • Chekol B
        • Eshetie D
        • Temesgen N.
        Assessment of staffing and service provision in the Post-Anesthesia Care Unit of Hospitals Found in Amhara Regional State, 2020.
        Drug Healthc Patient Saf. 2021; 13: 125-131
        • Apfelbaum JL
        • Silverstein JH
        • Chung FF
        • et al.
        Practice guidelines for postanesthetic care: an updated report by the American Society of Anesthesiologists Task Force on Postanesthetic Care.
        Anesthesiology. 2013; 118: 291-307
        • Jakobsson JG.
        Recovery and discharge criteria after ambulatory anesthesia: can we improve them.
        Curr Opin Anaesthesiol. 2019; 32: 698-702
        • Zhu Y
        • Yang S
        • Zhang R
        • et al.
        Using clinical-based discharge criteria to discharge patients after ophthalmic ambulatory surgery under general anesthesia: an observational study.
        J Perianesth Nurs. 2020; 35 (e1): 586-591
        • Chung F.
        Are discharge criteria changing.
        J Clin Anesth. 1993; 5: 64S-68S
        • Chung F.
        Recovery pattern and home-readiness after ambulatory surgery.
        Anesth Analg. 1995; 80: 896-902
        • Zhang Y.
        Study on the Influencing Factors of Time of Departure from Hospital in Patients Undergoing Sedated Gastroenteroscopy.
        Wenzhou Medical University, Zhejiang2020 (【Article in Chinese】)
        • Chung F
        • Chan VW
        • Ong D.
        A post-anesthetic discharge scoring system for home readiness after ambulatory surgery.
        J Clin Anesth. 1995; 7: 500-506
        • Lees-Deutsch L
        • Robinson J.
        A systematic review of criteria-led patient discharge.
        J Nurs Care Qual. 2019; 34: 121-126
        • ASPAN
        Perianesthesia Nursing Standards, Practice Recommendations and Interpretive Statements 2015-2017.
        American Society of PeriAnesthesia Nurses, Cherry Hill, NJ2015
        • Aldrete JA.
        Modifications to the postanesthesia score for use in ambulatory surgery.
        J Perianesth Nurs. 1998; 13: 148-155
        • White PF.
        Criteria for fast-tracking outpatients after ambulatory surgery.
        J Clin Anesth. 1999; 11: 78-79
        • Beatty AM
        • Martin DE
        • Couch M
        • Long N.
        Relevance of oral intake and necessity to void as ambulatory surgical discharge criteria.
        J Perianesth Nurs. 1997; 12: 413-421
        • Saar LM.
        Use of a modified Postanesthesia Recovery Score in phase II perianesthesia period of ambulatory surgery patients.
        J Perianesth Nurs. 2001; 16: 82-89
        • Truong L
        • Moran JL
        • Blum P.
        Post anaesthesia care unit discharge: a clinical scoring system versus traditional time-based criteria.
        Anaesth Intensive Care. 2004; 32: 33-42
        • Palumbo P
        • Tellan G
        • Perotti B
        • Pacilè MA
        • Vietri F
        • Illuminati G.
        Modified PADSS (Post Anaesthetic Discharge Scoring System) for monitoring outpatients discharge.
        Ann Ital Chir. 2013; 84: 661-665
        • Fraulini KE
        • Murphy P.
        R.E.A.C.T. A new system for measuring postanesthesia recovery.
        Nursing. 1984; 14: 101-102
        • Street M
        • Phillips NM
        • Kent B
        • Colgan S
        • Mohebbi M.
        Minimising post-operative risk using a Post-Anaesthetic Care Tool (PACT): protocol for a prospective observational study and cost-effectiveness analysis.
        BMJ Open. 2015; 5e007200
        • Prates A
        • Colognese B
        • Caumo W
        • Stefani LC.
        Development of a recovery-room discharge checklist (SAMPE checklist) for safe handover and its comparison with Aldrete and White scoring systems.
        Braz J Anesthesiol. 2021; 72: 200-206
        • Ecoff L
        • Palomo J
        • Stichler JF.
        Design and Testing of a Postanesthesia Care Unit Readiness for Discharge Assessment Tool.
        J Perianesth Nurs. 2017; 32: 389-399
        • Aldrete JA
        • Kroulik D.
        A postanesthetic recovery score.
        Anesth Analg. 1970; 49: 924-934
        • Chung F.
        Discharge criteria–a new trend.
        Can J Anaesth. 1995; 42: 1056-1058
        • Aldrete JA.
        The post-anesthesia recovery score revisited.
        J Clin Anesth. 1995; 7: 89-91
        • White PF
        • Song D.
        New criteria for fast-tracking after outpatient anesthesia: a comparison with the modified Aldrete's scoring system.
        Anesth Analg. 1999; 88: 1069-1072
        • Ead H.
        From Aldrete to PADSS: Reviewing discharge criteria after ambulatory surgery.
        J Perianesth Nurs. 2006; 21: 259-267
        • Rice AN
        • Douglas C
        • Bosarge H
        • Young G
        • Muckler VC
        • Vacchiano CA.
        Fast-tracking patients in an academic hospital to increase efficiency and decrease discharge delays: a process improvement plan.
        J Perianesth Nurs. 2021; 36: 615-621
        • Gilbertson LE
        • Patel C
        • De S
        • Lo W
        • Garcia-Roig M
        • Austin TM.
        The utilization of an opioid-free anesthetic for pediatric circumcision in an ambulatory surgery center.
        Children (Basel). 2021; 8: 678
        • Watkins AC
        • White PF.
        Fast-tracking after ambulatory surgery.
        J Perianesth Nurs. 2001; 16: 379-387
        • Ziemba-Davis M
        • Caccavallo P
        • Meneghini RM.
        Outpatient joint arthroplasty-patient selection: update on the outpatient arthroplasty risk assessment score.
        J Arthroplasty. 2019; 34: S40-S43
        • Clifford TL
        • Mamaril M
        • Sullivan E.
        The history of ASPAN standards.
        J Perianesth Nurs. 2005; 20: 380-384
        • Kramer KJ.
        Discharge criteria, impact of the patient and the procedure: what the oral surgeon should now.
        Oral Maxillofac Surg Clin North Am. 2017; 29: 197-208
        • Bailey CR
        • Ahuja M
        • Bartholomew K
        • et al.
        Guidelines for day-case surgery 2019: guidelines from the association of anaesthetists and the british association of day surgery.
        Anaesthesia. 2019; 74: 778-792
        • Abdullah HR
        • Chung F.
        Postoperative issues: discharge criteria.
        Anesthesiol Clin. 2014; 32: 487-493
        • Reed H.
        Criteria for the safe discharge of patients from the recovery room.
        Nurs Times. 2003; 99: 22-24