The first is essentially based on the assessment of vital signs (respiratory and cardiovascular) and is used for recovery from anesthesia for the assessment of restoration of consciousness, protective reflexes, and motility. It is indicated for recovery phase I, that is, for the discharge of the patient from the recovery room to the ward for observation. The second system evaluates the vital parameters in a single item and associates the evaluation of other functions that can ensure the restoration of activities which will allow the return home, such as the ability to stand stably, the presence of nausea and vomiting, adequate pain control, and bleeding of the surgical wound. The PADSS is used for discharge home phase II recovery. Patients achieving a total score of 9 or 10 are considered fit for transfer or discharge to the next phase of recovery.

Recently, the Société Française d’Anesthésie et de Réanimation (SFAR) published a prospective observational study in which PADSS is applied in the pediatric population, defining Ped-PADSS pediatric discharge score in ambulatory surgery [46] (Table 5.2).

An analysis of the literature does not provide data on the minimum time of postoperative observation. Previously, a postoperative observation period of at least 4 hours was required; today, as reported by SFAR, 95 % of patients have the Ped-PADSS ≥9 after two hours of observation. A more recent study [47] including 1060 children and using Ped-PADSS, 97.2 % of children could be discharged one hour after returning from the operating room, and 99.8 % of children were dischargeable two hours after. Therefore, it is advisable, but not required, that patients remain in the hospital for at least four hours postoperatively, but the time may vary depending on the organizational model, as long as the scoring system is used and patients are fully satisfied at discharge.

Discharge must be decided by the surgeon or the anesthesiologist but, according to the Joint Commission Accreditation, can be carried out by educated and empowered personnel according to the procedure in use in the institution.

The child should be entrusted to a responsible adult who can take the patient back to the hospital for any need. Means of transportation and/or the possibility of a telephone to call for help should be available.

Postoperative management indications must be written, may be differentiated by type of procedure, should be handed to the parents or the adult responsible, and explained in a comprehensible manner with the aid of a mediator, if needed.

Prescriptions for pain therapy, including the rescue dose, must be clear and precise. Could the family report difficulty in finding the first home administration, the structure should provide it.

A telephone follow-up could be made the day after surgery to determine the frequency of complications, including minor ones not requiring hospitalization, and to report on the child’s condition and resumption of daily activity (information on meals, sleep disorders, recovery motor activity). Monitoring pain control at home is also part of patient care according to the standards of the Joint Commission of Accreditation.