Predictors of unanticipated admission following ambulatory surgery: a retrospective case-control study

Abstract

Purpose The primary objectives of this historical casecontrol study were to evaluate the incidence of and reasons and risk factors for adult unanticipated admissions in three tertiary care Canadian hospitals following ambulatory surgery. Methods A random sample of 200 patients requiring admission (cases) and 200 patients not requiring admission (controls) was taken from 20,657 ambulatory procedures was identified and compared. The following variables were included: demographics, reason for admission, type of anesthesia, surgical procedure, length of procedure, American Society of Anesthesiologists' (ASA) classification, surgical completion time, pre-anesthesia clinic, medical history, medications (classes), and perioperative complications. Multiple logistic regression analysis was used to assess factors associated with unanticipated admissions. ResultsThe incidence of unanticipated admission following ambulatory surgery was 2.67%. The most common reasons for admission were surgical (40%), anesthetic (20%), and medical (19%). The following factors were found to be associated with an increased risk of unanticipated admission: length of surgery of one to three hours (odds ratio [OR] Author contributions Amanda Whippey, Greg Kostandoff, James Paul, Jinhui Ma, and Lehana Thabane helped design the study and write the manuscript. Amanda Whippey, Greg Kostandoff, and James Paul helped conduct the study. Heung Kan Ma helped in data collection, and Jinhui Ma and Lehana Thabane helped analyze the data. James Paul is the author responsible for archiving the study files. Amanda Whippey, Greg Kostandoff, Jinhui Ma, James Paul, Lehana Thabane, and Heung Kan Ma have seen the original study data. Amanda Whippey, Greg Kostandoff, Jinhui Ma, James Paul, and Lehana Thabane reviewed the analysis of the data. 0.08 to 0.33), and dental/ear-nose-throat surgery (OR 0.32; 95% CI 0.13 to 0.83) when compared with general surgery. Other comorbid conditions did not impact unanticipated admission. Conclusion Unanticipated admission after ambulatory surgery occurs mainly due to surgical, anesthetic, and medical complications. Length of surgery more than one hour, high ASA class, advanced age, and increased BMI were all predictors. No specific comorbid illness was associated with an increased likelihood of unanticipated admission. These findings support continued use of the ASA classification as a marker of patient perioperative risk rather than attributing risk to a specific disease process. RésuméObjectif Les objectifs primaires de cette e´tude cas-te´moin historique e´taient d'e´valuer l'incidence ainsi que les raisons et les facteurs de risque des admissions non anticipe´es de patients adultes dans trois hôpitaux canadiens de soins tertiaires apre`s une chirurgie ambulatoire. dentaire / oto-rhino-larynge´e (ORL) (RC 0,32; IC 95 % 0,13 a`0,83) par rapport a`une chirurgie ge´ne´rale. Aucun impact sur les admissions non anticipe´es n'a e´te´observeá vec d'autres comorbidite´s. Conclusion Les admissions non anticipe´es apre`s une chi...

Impact of ambulatory surgery day of the week on postoperative outcomes: a population-based cohort study

“…3,4 Although mortality following ambulatory surgery is rare, over 3% of patients may require unplanned acute postoperative medical care, such as hospital admission, emergency department (ED) visits, or hospital readmission, often within the first week. [4][5][6] Discharge of hospital inpatients on Friday has been associated with increased rates of death and urgent hospital admission within 30 days, possibly because of a lack of service access over the weekend. 7 Beyond the impact of discharge day, evidence from a variety of areas of clinical medicine suggests that the day of the week on which medical care is provided may have a significant impact on health outcomes.…”

Management of comorbidities in ambulatory anesthesia: a review

“…Administrative data analyses which focused on readmission outcome noted that prolonged surgical duration, cerebrovascular disease, obesity, and cardiac disease increased the risk after outpatient surgery. 17, 18 Whippey et al 17 recently reported that surgeries lasting longer than 1 hour, high ASA (American Society of Anesthesiologists) physical status classification ($ASA 3), advanced age (80 years or older), and increased BMI were identified as predictors of unplanned hospital admission. A recent large-scale Danish study 19 of a prospective cohort of 57,709 DS procedures collected from eight DS centers over a 3-year period also confirmed the safety of DS, reporting a very low rate of return hospital visits (1.21%).…”

“…9,17,[22][23][24][25][26] Overall, the most encountered adverse events were cardiovascular -in cardiac patients; or postoperative respiratory -in asthmatic, morbidly obese, and sleep apnea patients. 10 Recognition and optimization of comorbid medical conditions in advance of the day of surgery is crucial because it enables implementation of perioperative preventative measures that minimize adverse events.…”

An analysis of risk factors and adverse events in ambulatory surgery

“…1 From an ambulatory surgery database of over 20,000 encounters, 200 randomly selected patients who were admitted after ambulatory surgery were compared with 200 randomly selected patients who did not require admission. This study did not examine which specific adverse events led to admission, beyond noting that surgical factors accounted for 40% of admissions, anesthetic factors for 20%, and medical factors for 19%.…”