Factors Affecting Unanticipated Hospital Admission Following Otolaryngologic Day Surgery

Abstract

Backgroiitid: Day surgery constitutes an important part of tnodern otolaryngology practice. However, high rates of unplanned admissions remain an issue. Objeciive: To determine the incidence, reasons, and predictive factors for unanticipated admission after ambulatory otolaryngologic surgery. Methods: A retrospective rcviev^' of all cases of unplanned admission following orolaryngology day surgery at a tertiary care centre over a 4-year period from 2000 to 2004. Data relating to patient demographics, physical status, surgical procedure, perioperativc complications, and reasons for hospital admission were recorded. A case-control analysis of these parameters with nonadmitted d;iy surgery patients was used for comparison. Results: During the above period, 1106 patients underwent otolaryngologic day surgery, of whom 74 {6.7%) required admission. Fifty-seven percent of the patients were male, and the average age was 48.9 years. The three most common procedures with unplanned admission were open neck biopsy (27%), functional endoscopic sinus surgery (20.3%), and pancndoscopy (16.2%). "rhe reasons for admission could he divided into airway monitoring (37.7%), postoperative bleeding (28.6*>ii), tbe need for supportive or pain management (19.5%), anesthetic complication (5.2%), cardiovascular complication (3.9%), clerical error (3.9%), and suspicion of a cerebrospinal fluid leak (1.3%). Risk factors for admission were determined to be an American Society of Anesthesiologists' class of 3 or greater, open neck surgical procedures, and a length of surgery of 60 minutes or greater. Minor factors included the use of general anesthesia, male gender, advanced age, and living far from a hospital. Conclusions: This study suggests strategies to reduce [he r^ite of unplanned admission by means of Ciirefiil preoperative assessment and planning, patient selection, careful scheduling of higlier-dsk patients, and appropriate postoperative observation and management. SommaireIntroduction: La chirurgie d'un jour est devenue une partie importante de la pratique ORL moderne. Par contre, les admissit)ns post-operatoires imprevues deiiieiirent iin probleme. Objectif: Determiner I'incidence, les causes et les facteurs predictifs d'admission non prevues apres une chirurgie ORL en ambulatoirc. Methode: Revue retrospective de tous les cas non prevus d'admission apres une cbirurgie ORL ambulatoire dans un centre tertiaire entre 2000 et 2004. Nous avons collige les donnees demographiequcs, le sratut physique, les procedures chirurglcales, les complications peri-operatoires et les raisons pour I'hospitalisation. A des fins de comparaison, nous avons apparie ces patients avcc des controlcs qui eux n'ont pas etc admis. Rc'sukats: Des 1106 patit-nts rraites en ambulatoire, 74 [6.7%) ont etc admis apres leur intervention. Cinqunnte-sept pourcent de ces patients etaient des hommes et leur moyenne d'age etait de 48.9 ans. Les procedures qui ont mene a la majorite de ces admissions sont la biopsie ouverte d*un ganglion cervical (27%), la chirurgie endosco...

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