In recent decades, advances in minimally invasive techniques, anesthesia, and postoperative recovery protocols have allowed many procedures that once required hospitalization to be performed on an outpatient or short-stay basis. One model that has gained increasing adoption is 23-hour observation following surgery. This approach provides an intermediate option between same-day discharge and full inpatient admission, balancing safety, efficiency, and patient satisfaction.
The 23-hour observation model is designed to provide extended postoperative monitoring without committing a surgery patient to a traditional hospital admission. The goal is to ensure that patients recover safely from while avoiding unnecessary hospital stays. Clinicians remain closely involved with care during the observation period, allowing them to detect early complications, manage pain effectively, and provide adequate education before the patient transitions home. For patients undergoing procedures with moderate risk or those who may not be ready for same-day discharge, this observation period offers a valuable compromise 1,2.
A wide range of surgical procedures can qualify for 23-hour observation, including laparoscopic cholecystectomy, hernia repair, orthopedic interventions, and certain gynecologic or urologic surgeries. Patients with underlying medical conditions or who have undergone procedures with higher risks of postoperative pain or bleeding may need closer monitoring. In some cases, patients undergoing complex outpatient procedures benefit from this extended stay to ensure stability before discharge 1,3,4.
The advantages of 23-hour observation after surgery are multifaceted. Because patients remain under professional supervision during the immediate recovery period, this approach reduces anxiety for both patients and families while ensuring timely intervention if complications arise. In this controlled environment, pain management can be optimized, nausea and vomiting can be addressed, and mobility can be assessed. For healthcare providers and systems, the model supports efficient use of hospital resources. It reduces the burden on inpatient beds while still providing structured postoperative care. Financially, 23-hour observation can lower costs compared with full admissions—though these savings may not always be clear—while remaining reimbursable by many insurers. This model also aligns with the broader trend of shifting surgical care toward outpatient and short-stay settings.
Despite its benefits, the 23-hour observation model requires careful planning. Not all patients are suitable candidates. Those with significant comorbidities, high risk of complications, or social circumstances that limit support at home may require longer inpatient care. Facilities must also ensure adequate staffing, appropriate monitoring equipment, and clear protocols for transitioning patients home or admitting them if extended care is needed. Communication with patients is vital, as these patients need to understand the purpose of observation, expected recovery milestones, and discharge instructions 1,2. Nonetheless, many surgeries are well suited to a purely outpatient model with same-day discharge, though patient selection and optimization remain essential.
The 23-hour observation period after surgery represents a flexible and patient-centered approach to postoperative care. It bridges the gap between outpatient and inpatient management, offering safety, comfort, and efficiency. By enabling the early detection of complications, optimizing recovery, and reducing unnecessary hospital stays, this model supports modern surgical practice and enhances patient outcomes.
References
1. Ruohoaho, U. ‐M. et al. Implementation of a 23‐h surgery model in a tertiary care hospital: a safe and feasible model with high patient satisfaction. BJS Open 4, 391–399 (2020). DOI: 10.1002/bjs5.50267
2. Ardon, A. E., Nimma, S. & Nin, O. C. Twenty-three-hour stays in the ambulatory surgical center: benefits, pathways and protocols. Curr Opin Anaesthesiol 36, 617–623 (2023). DOI: 10.1097/ACO.0000000000001306
3. Raspanti, C. et al. 23-hour observation endocrine neck surgery: lessons learned from a case series of over 1700 patients. G Chir 38, 15–22 (2017). DOI: 10.11138/gchir/2017.38.1.015
4. 37 ASCs with 23-hour stays. Becker’s ASC https://www.beckersasc.com/lists/36-ascs-with-23-hour-stays/ (2016).
5. Why You May Pay More If You Are Hospitalized for Observation. Verywell Health https://www.verywellhealth.com/an-explanation-of-inpatient-v-observation-status-1738455.
6. Inpatient or outpatient hospital status affects your costs | Medicare. https://www.medicare.gov/coverage/inpatient-hospital-care/inpatient-outpatient-status.
7. Burke, C. C., Zabka, C. L., McCarver, K. J. & Singletary, S. E. Patient satisfaction with 23-hour ‘short-stay’ observation following breast cancer surgery. Oncol Nurs Forum 24, 645–651 (1997).