title: Office-based ambulatory anesthesia: Factors that influence patient satisfaction or dissatisfaction with deep sedation/general anesthesia.
abstract: OBJECTIVE
  The purpose of this report was to analyze data collected in an outcomes study in an attempt to identify factors that may be significant predictors of either patient satisfaction or dissatisfaction with deep sedation/general anesthesia (DS/GA) administered in an office-based setting.
  
  
  METHODS
  To address the research purpose, we used a prospective cohort study design and sample of patients undergoing procedures in the office-based ambulatory setting of oral and maxillofacial surgeons practicing in the United States who received local anesthesia (LA), conscious sedation (CS), or DS/GA. The predictor variables were categorized as demographic, anesthetic technique, adverse events, and patient-oriented outcomes (satisfaction/dissatisfaction). Appropriate descriptive and exact P values were completed as indicated. Statistical significance was set at P < .05. Multivariate analyses were performed to support the interpretation of univariate findings.
  
  
  RESULTS
  The sample was composed of 34,191 patients, of whom 71.9% patients received DS/GA. There were 20,455 patient satisfaction forms completed, of which 14,912 forms were from patients undergoing DS/GA. Of patients who received DS/GA, 95.8% were extremely or moderately satisfied, 3.1% were neutral, and 1.1% moderately or extremely dissatisfied. Increased age and memory of postoperative instructions were identified as factors, which predicted satisfaction. The addition of nitrous oxide to some regimens also appeared to increase satisfaction. Young age, anxiety, pain, vomiting, and being awake during the procedure were predictors of dissatisfaction.
  
  
  CONCLUSIONS
  The findings of this study indicate that patients are overwhelmingly satisfied with DS/GA provided in an office-based ambulatory setting. Items identified as significant predictors of dissatisfaction (anxiety, pain, vomiting, being awake) generally confirm preexistent suppositions. Surprisingly, patient age (<10 years old) and memory of postoperative instructions appear to have relevance to dissatisfaction as well. Lack of specific regimens and controls prevents confirmation that nitrous oxide improves patient satisfaction rates. Although statistically significant, the variations, which resulted in a higher or lower satisfaction rate, are of questionable clinical significance in many cases.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center at Houston, Sugarland, TX 77478, USA.
authors.forename: Timothy T
authors.initials: TT
authors.lastname: Coyle
authors.forename: John F
authors.initials: JF
authors.lastname: Helfrick
authors.forename: Martin L
authors.initials: ML
authors.lastname: Gonzalez
authors.forename: Randi V
authors.initials: RV
authors.lastname: Andresen
authors.forename: David H
authors.initials: DH
authors.lastname: Perrott
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000523:psychology*; D000704:Analysis of Variance; D000766:Anesthesia, Dental / Q000379:methods* / Q000523:psychology; D000768:Anesthesia, General / Q000523:psychology*; D002648:Child; D015331:Cohort Studies; D016292:Procedural Sedation / Q000523:psychology*; D016854:Dental Anxiety; D003770:Dental Offices; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D020250:Postoperative Nausea and Vomiting; D011446:Prospective Studies; D014851:Wakefulness