Factors Affecting Discharge Time in Adult Outpatients

Abstract

The relative importance of anesthetic and nonanesthetic factors were evaluated as determinants of discharge time after ambulatory surgery. Postoperative nursing care was the single most important factor after general anesthesia; anesthetic drugs, anesthetic technique, and prevention of pain and emetic symptoms were of selective importance depending on patient gender and type of surgery.

Delayed discharge and acceptability of ambulatory surgery in adult outpatients receiving general anesthesia

“…Previous reports demonstrated that duration and type of surgery are important factors determining the length of stay [3,6,[7][8][9][10]17,18], which is consistent with our study. Our delayed patients used more intraoperative and postoperative analgesics and reported more frequent postdischarge pain.…”

“…In this study, we have confirmed the previous reports demonstrating that delays in discharge are due to adverse symptoms or social/system problems [3,[6][7][8][9][10][11][12][13][14][15][16][17][18][19]. In addition, we found that delayed discharge was associated with increased postdischarge pain, lower RNA level, and patient's unwillingness to receive same-day surgery again.…”

“…We arbitrarily defined discharge time Ն270 min (mean ϩ 1SD) as delay in discharge because discharge time Ն mean ϩ 1SD was apparently unusual (13% of our patients) and Ն mean ϩ 2SD obviously extraordinary (3%). Chung regarded delay in discharge as stay Ն30 min after a PADSS score Ն9 was obtained (54% of her patients) [17]; Pavlin et al, stay Ն50 min in phase 1 recovery (72% or 59% of their patients) or Ն70 min in phase 2 recovery (63% or 66%) [6,18]; and Junger et al, postoperative stay Ͼ180 min (81%) [8]. According to their definitions, the majority of their patients and all or most of our patients were classified as "delayed."…”

“…Therefore, it is of interest to identify the reasons that may lead to prolonged discharge time, or the length of time from the end of surgery until a patient is discharged home. Discharge time and the rate of unanticipated admissions are commonly used as a measure of efficacy and an indicator of outcome in ambulatory surgery [6][7][8][9][10].…”

“…Previous studies have suggested that the factors for increasing discharge time and unanticipated admission rate are postoperative adverse symptoms, cardiovascular events, type of surgery, and duration of surgery [3,[6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Although common side effects after ambulatory surgery such as pain, nausea, vomiting, dizziness, drowsiness, and fatigue may impair patient acceptability of ambulatory surgery, it is not necessarily selfevident that prolongation of discharge time is associated with a patient's unwillingness to receive a surgery at outpatient settings.…”