Journal of Anesthesia

, Volume 32, Issue 2, pp 309–309 | Cite as

Does local factors alter discharge times after surgery?

  • Mark C. Kendall
  • Lucas J. Castro-Alves
Letter to the Editor

To the Editor:

We read with great interest the article of Nishida et al. [1] in a recent issue of the journal. The authors evaluated patients < 18 years of age who underwent pediatric ambulatory surgery under general anesthesia and concluded that increased time spent in a hospital was affected by the type of regional block, surgery, and intraoperative fluid volume. The authors should be congratulated for performing a well-designed trial in an important topic in pediatric patients [2]. Moreover, current emphasis on fluid management and regional blocks as a part of enhanced recovery protocols makes the topic more relevant [3].

There are some questions that need to be clarified to determine the validity of the results. First, the authors arbitrarily defined prolonged stay as within 8 h at the end of anesthesia. It would be important to perform a sensitivity analysis to demonstrate if their results differ when other time cutoffs are utilized (e.g., 6 and 4 h). Second, it is unclear how frequent patients were assessed using the PADSS instrument and if the results can be affected by bias on unstandardized discharge evaluations. Last, most studies examining discharge times demonstrate < 3 h. One could argue that the discharge time in this study is driven by practice characteristics and therefore, poor generalizability to other centers.



No funding was sought.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest and nothing to disclose.


  1. 1.
    Nishida T, Mihara T, Ka K. Predictors for incidence of increased time spent in hospital after ambulatory surgery in children: a retrospective cohort study. J Anesth. 2017. Scholar
  2. 2.
    Cai Y, Lopata L, Roh A, Huang M, Monteleone MA, Wang S, Sun LS. Factors influencing postoperative pain following discharge in pediatric ambulatory surgery patients. J Clin Anesth. 2017;39:100–4.CrossRefPubMedGoogle Scholar
  3. 3.
    Schol PB, Terink IM, Lancé MD, Scheepers HC. Liberal or restrictive fluid management during elective surgery: a systematic review and meta-analysis. J Clin Anesth. 2016;35:26–39.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2018

Authors and Affiliations

  1. 1.Department of Anesthesiology, Rhode Island HospitalWarren Alpert Medical School of Brown UniversityProvidenceUSA

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