Factors Associated With Unanticipated Admission After Outpatient Endoscopic Sinonasal Surgery

Abstract

Objectives/Hypothesis: To identify factors that may increase the risk of unplanned admission following elective outpatient endoscopic sinonasal surgery (ESS).Study Design: Retrospective analysis of the National Surgical Quality Improvement Program (NSQIP).Methods: All cases of ESS were extracted from the 2010 to 2018 NSQIP database using Current Procedural Terminology codes. Only cases coded as outpatient, elective, and nonemergent procedures were included. Unplanned admissions were defined as cases with a total hospital stay of 1 day or more. Univariate and multivariate analyses were performed to identify variables that independently predicted unanticipated admission.Results: A total of 971 cases met inclusion criteria, of which 274 (28.2%) were unanticipated admissions. Patients in the unplanned admission group were more likely to be older (46.8 vs. 41.1 years, P < .001), male (57.7% vs. 48.4%, P = .009), obese (54.8% vs. 43.8%, P = .003), and have hypertension (35.0% vs. 25.0%, P = .002). Unplanned admitted patients were also more likely to be included under American Society of Anesthesiologists (ASA) classification III-IV (43.1% vs. 27.2%, P < .001). There were no significant differences in race, smoking, diabetes, or chronic steroid use. Unplanned admitted patients had a higher rate of surgical complications (2.9% vs. 1.0%, P = .041). Upon multivariate analysis, independent preoperative risk factors for unplanned admission included age (OR: 1.018, P = .002), male gender (OR: 1.415, P = .025), obesity (OR: 1.527, P = .008), and ASA III-IV (OR 1.501, P = .018).Conclusions: Factors independently associated with unplanned admission following outpatient ESS were older age, male gender, obesity, and higher ASA. Identification of patients at risk may reduce unanticipated hospital admission after ESS.

Impact of Facility Volume on Patient Safety Indicator Events After Transsphenoidal Pituitary Surgery

“…However, this result may be more representative of this specific NIS‐based cohort, as other studies investigating the role of patient sex on complication rates following TSPS showed no difference 9,26 . Moreover, older patients have been shown to experience higher rates of postoperative complications following TSPS, paralleling our study's findings 27 …”

“…9,26 Moreover, older patients have been shown to experience higher rates of postoperative complications following TSPS, paralleling our study's findings. 27 Our results indicate that treatment at HVFs correlates with lower rates of PSI events, poor outcomes, and in-hospital mortality when compared with LVFs and MVFs. As PSI events are representative of postoperative complications, the results suggest that HVFs offer superior outcomes and postoperative care for patients with TSPS.…”