Factors influencing unexpected disposition after orthopedic ambulatory surgery

Abstract

Study Objective To analyze whether patient characteristics, ambulatory facility type, anesthesia provider and technique, procedure type, and temporal factors impact the outcome of unexpected disposition after ambulatory knee and shoulder surgery. Design Retrospective analysis of a national database. Setting Freestanding and hospital-based ambulatory surgery facilities. Measurements Ambulatory knee and shoulder surgery cases from 1996 and 2006 were identified through the National Survey of Ambulatory Surgery. The incidence of unexpected disposition status was determined and risk factors for such outcome were analyzed. Main Results Factors independently increasing the risk for unexpected disposition included procedures performed in hospital-based versus freestanding facilities [odds ratio (OR) 6.83 (95% confidence interval [CI] 4.34; 10.75)], shoulder versus knee procedures [OR 3.84 (CI 2.55; 5.77)], anesthesia provided by nonanesthesiology professionals and certified registered nurse-anesthetists versus anesthesiologists [OR 7.33 (CI 4.18; 12.84) and OR 1.80 (CI 1.09; 2.99), respectively]. Decreased risk for unexpected disposition were found for procedures performed in 2006 versus 1996 [OR 0.15 (CI 0.10; 0.24)] and the use of anesthesia other than regional and general [OR 0.34 (CI 0.18; 0.68)]. Conclusions The decreased risk for unexpected disposition associated with more recent data and with freestanding versus hospital-based facilities may represent improvements in efficiency, while the decreased odds for such disposition status associated with the use of other than general and regional anesthesia may be related to a lower invasiveness of cases. We found an increased risk of adverse disposition in cases where the anesthesia provider was a nonanesthesiology professional. No difference in this outcome was noted when an anesthesia care team provided care.

Perioperative Comparative Effectiveness of Anesthetic Technique in Orthopedic Patients

“…21,22 Examining the impact of the type of anesthesia in a cohort limited to hip fracture patients in New York, Neuman et al . 22 discovered beneficial effects of regional versus general anesthesia in respect to mortality and pulmonary complications.…”

Trends in the Use of Regional Anesthesia

“…28,[35][36][37] In this context, large database studies have recently gained widespread interest and addressed questions of comparative effectiveness of various anesthetic techniques. 26,38 Other drivers in anesthesia practice include institutional preferences and physician-or patient-related factors. 26 Surveys among practicing anesthesiologists have shown that adequate training poses a major driving factor in the application of regional anesthesia.…”

Association of peripheral nerve blocks with postoperative outcomes in ambulatory shoulder surgery patients: a single-centre matched-cohort study

“…3 Furthermore, shoulder surgery is associated with a three-fold increase in unanticipated hospital admissions compared with other orthopedic ambulatory surgeries. 4 Specific reasons for this association are unclear. Nevertheless, since shoulder surgery is one of the most painful common surgeries, 3,5 anesthesiology care may be particularly important in influencing patient-centred and health system outcomes.…”