Emergency department use and hospital admission in children following ambulatory surgery: a retrospective population-based cohort study

Sawhney, Mona; VanDenKerkhof, Elizabeth G.; Goldstein, David H.; Wei, Xuejiao; Paré, Geneviève C.; Mayne, Ian P.; Tranmer, Joan

doi:10.1136/bmjpo-2021-001188

Cited by 4 publications

(3 citation statements)

References 15 publications

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“…The most common reasons for visiting the emergency room were pain (17.2%) and bleeding (10.5%). Reasons for readmission included bleeding (24.8%), dehydration (21.9%) and pain (9.1%) [35]. Sheffer et al investigated the above in pediatric orthopedic procedures and found a 30-day ReAd of 0.42% [36].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors Leading to Overnight Stays in Pediatric Surgical Outpatients

Bašković,

Markanović,

Ivanović

et al. 2024

Children

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Background: Same-day surgery implies patient discharge on the same day after the surgery. The main aim of the research was to determine which predisposing factors lead to children treated with same-day surgery not being able to be discharged on the same day. Methods: For the purposes of this research, the electronic records of patients in the hospital information system were reviewed retrospectively. The search included patients who were surgically treated through the Day Surgery Unit at the Children’s Hospital Zagreb with various diagnoses from 1 January 2021 to 31 December 2023. The target group consisted of patients who could not be discharged on the same day (n = 68), while for the purposes of the control group (n = 68), patients were randomly selected, comparable by age and gender, who were discharged from the hospital on the same day in accordance with the principles of same-day surgery. Results: In relation to the parameters of interest between the groups, statistically significant differences were observed in the type of general anesthesia (p = 0.027), the use of analgesics (p = 0.016), the time of entering the operating room (p = 0.000), the time of leaving the operating room (p < 0.0001) and the duration of surgery (76.81 ± 37.21 min vs. 46.51 ± 22.46 min., p < 0.0001). When explanatory variables were included in the regression model, they explained 38% of the variability in the dependent variable. Only the variable “duration of surgery” provided significant information to explain the variability in the dependent variable (p = 0.004). Conclusions: Although the duration of surgery was imposed as the main predictor of hospitalization after same-day surgery, and considering the extremely small number of studies on the mentioned topic, especially in the pediatric population, further, preferably multicenter research on the mentioned topic is needed.

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Section: Discussionmentioning

confidence: 99%

Risk Factors Leading to Overnight Stays in Pediatric Surgical Outpatients

Bašković,

Markanović,

Ivanović

et al. 2024

Children

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“…Ultimately, clinicians need not vary postoperative medication prescriptions based on patient demographic or injury characteristics. Pain is a common driver of unplanned emergency department visits after pediatric ambulatory surgery 18 . Establishing evidence-based thresholds for normative pain after procedures helps clinicians and families to set expectations for postoperative pain management.…”

Section: Discussionmentioning

confidence: 99%

“…Pain is a common driver of unplanned emergency department visits after pediatric ambulatory surgery 18 . Establishing evidence-based thresholds for normative pain after procedures helps clinicians and families to set expectations for postoperative pain management.…”

Section: Discussionmentioning

confidence: 99%

Opioid Analgesia Compared with Non-Opioid Analgesia After Operative Treatment for Pediatric Supracondylar Humeral Fractures

Belardo,

Talwar,

Blumberg

et al. 2023

Journal of Bone and Joint Surgery

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Background: Minimal pain and opioid use after operative treatment for pediatric supracondylar humeral fractures have been previously described; however, opioid-prescribing practices in the United States remain variable. We hypothesized that children without an opioid prescription would report similar postoperative pain compared with children prescribed opioids following closed reduction and percutaneous pinning (CRPP) of supracondylar humeral fractures. Methods: Children who were 3 to 12 years of age and were undergoing CRPP for a closed supracondylar humeral fracture were prospectively enrolled in a multicenter, comparative study. Following a standardized dosing protocol, oxycodone, ibuprofen, and acetaminophen were prescribed at 2 hospitals (opioid cohort), and 2 other hospitals prescribed ibuprofen and acetaminophen alone (non-opioid cohort). The children’s medication use and the daily pain that they experienced (scored on the Wong-Baker FACES Scale) were recorded at postoperative days 1 to 7, 10, 14, and 21, using validated text-message protocols. Based on an a priori power analysis, at least 64 evaluable subjects were recruited per cohort. Results: A total of 157 patients were evaluated (81 [52%] in the opioid cohort and 76 [48%] in the non-opioid cohort). The median age at the time of the surgical procedure was 6.2 years, and 50% of the subjects were male. The mean postoperative pain scores were low overall (<4 of 10), and there were no significant differences in pain ratings between cohorts at any time point. No patient demographic or injury characteristics were correlated with increased pain or medication use. Notably, of the 81 patients in the opioid cohort, 28 (35%) took no oxycodone and 40 (49%) took 1 to 3 total doses across the postoperative period. Patients rarely took opioids after postoperative day 2. A single patient in the non-opioid cohort (1 [1%] of 76) received a rescue prescription of opioids after presenting to the emergency department with postoperative cast discomfort. Conclusions: Non-opioid analgesia following CRPP for pediatric supracondylar humeral fractures was equally effective as opioid analgesia. When oxycodone was prescribed, 84% of children took 0 to 3 total doses, and opioid use fell precipitously after postoperative day 2. To improve opioid stewardship, providers and institutions can consider discontinuing the routine prescription of opioids following this procedure. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

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Day surgery in children: 15-year analysis of unplanned admissions at a Japanese tertiary children’s hospital

Sueda,

Kagawa,

Kojima

2024

J Anesth

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Purpose Unplanned hospital admission following pediatric day surgery is a crucial quality indicator. This study examined the incidence, related risks, interventions, and outcomes of unplanned hospital admission following pediatric day surgery among children in Japan. Methods This single-center, retrospective study analyzed data of 14,529 pediatric patients under the age of 18 years who underwent day surgery between August 2007 and December 2022. Unplanned hospital admission was defined as an overnight hospital stay that was not planned preoperatively, including patients who returned to the emergency department and required admission within 24 h of discharge. Reasons for unplanned hospital admission and interventions were categorized, and risk factors were identified using logistic regression. Results The incidence of unplanned hospital admission was 0.19%. The most common reasons for unplanned hospital admission were anesthetic-related, particularly postoperative nausea and vomiting (36%), which was managed primarily with intravenous fluids (36%) and antiemetic medications (21%). Medical and surgical factors were next most common. Logistic regression identified longer operation time (adjusted Odds ratio 1.03; 95% confidence interval [1.01, 1.04]; P < 0.001) and exit from the operating room after 15:00 (adjusted Odds ratio 29.3; 95% confidence interval [7.09, 121]; P < 0.001) as significant risk factors for unplanned hospital admission. Conclusion Unplanned hospital admission was most commonly anesthetic-related and was managed with intravenous fluids and antiemetic medications. Longer operation time and later exit from the operating room were significant risk factors. These findings can guide targeted strategies to further reduce unplanned hospital admission and improve pediatric day surgery quality.

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Emergency department use and hospital admission in children following ambulatory surgery: a retrospective population-based cohort study

Cited by 4 publications

References 15 publications

Risk Factors Leading to Overnight Stays in Pediatric Surgical Outpatients

Risk Factors Leading to Overnight Stays in Pediatric Surgical Outpatients

Opioid Analgesia Compared with Non-Opioid Analgesia After Operative Treatment for Pediatric Supracondylar Humeral Fractures

Day surgery in children: 15-year analysis of unplanned admissions at a Japanese tertiary children’s hospital

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