Fast-Tracking and Modified Aldrete Score

Vimmi Kang, DO

New Criteria for Fast-Tracking After Outpatient Anesthesia: A Comparison with the Modified Aldrete’s Scoring System

Paul F. White, PhD, MD, FANZCA and Dajun Song, MD, PhD

A & A May 1999 vol. 88 no. 51069-1072

The modified Aldrete’s scoring system is commonly used for determining when patients can be safely discharged from the PACU to either the postsurgical ward or to the second stage (Phase II) recovery area. Recently, these discharge criteria have also been used in the OR to determine the fast-track eligibility of outpatients undergoing ambulatory surgery. The modified Aldrete’s scoring system is a highly acceptable criteria for discharging patients from the PACU. However, this scoring system was not designed to assess the patient’s ability to bypass the PACU after major ambulatory procedures under general anesthesia. So a new criteria was compared to the modified Aldrete scoring system to see which one was more structured to fit fast tracking after outpatient anesthesia.

Recovery data from 216 consenting female outpatients undergoing either laparoscopic tubal ligation or cholecystectomy procedures at the University of Texas Southwestern Medical Center at Dallas from January 1997 through July 1998 were analyzed. General anesthetics were either maintained by inhaled anesthetics (desflurane, sevoflurane) or Propofol. Early recovery status was evaluated at 1-min intervals after termination of the anesthetics using both the modified Aldrete scoring system  and the new fast-track scoring system. Patients were considered fast-track–eligible if they achieved a score of 10 using the modified Aldrete scoring system or a score of ≥12 (with no score <1 in any individual category) using the new scoring system.

In conclusion, The results from this data evaluation demonstrated that 22%–29% of outpatients judged fast-track–eligible using the modified Aldrete scoring system subsequently required IV analgesics and antiemetics. Although these patients were fully oriented and had stable vital signs, they would have added to the workload of the Phase II nursing staff and may have necessitated the use of more extensive monitoring in the step-down unit. So, the new fast-track scoring system seems to offer advantages over the modified Aldrete’s scoring system in evaluating the suitability of outpatients for bypassing the PACU after undergoing ambulatory surgery with general anesthesia.