Safe Selection: A Multi-Center Analysis of Exclusion Criteria in Pediatric Ambulatory Surgery Centers

Background: In the United States, over a quarter of outpatient pediatric procedures take place in ambulatory surgery centers (ASCs). Previous studies have identified substantial variability in clinical staffing, pediatric-specific training, and policy development among ASCs that provide pediatric care. Aims: To characterize and compare the exclusion criteria currently used in ASCs affiliated with pediatric hospital systems across the continental United States. Methods: In this descriptive study, we solicited exclusion guidelines from the 30 largest pediatric hospitals representing each geographic region in the continental United States. Additionally, we surveyed each institution regarding the physical configuration of its ambulatory surgery center, as well as the availability of ancillary site support and the center's proximity to the parent institution. Results: While there was general consistency in excluding children with a history of congenital heart disease, pulmonary conditions, and difficult airway, we found considerable heterogeneity in minimum age thresholds, obesity criteria, and recent respiratory infection. Additionally, there was variation in ambulatory surgery center proximity to its parent institution, resources available at the facility, and capacity for extended observation beyond same-day discharge. Conclusions: These findings highlight the need for standardized, evidence-based guidelines that balance consistency with site-specific flexibility to ensure safe and efficient care for pediatric patients in ambulatory surgery settings.