Retrospective evaluation of unanticipated admissions and readmissions after same day surgery and associated costs

Coley, Kim C.; Williams, Brian A.; DaPos, Stacey V.; Chen, Connie; Smith, Randall B.

doi:10.1016/s0952-8180(02)00371-9

Cited by 317 publications

(200 citation statements)

References 9 publications

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“…In the same way, we found high replacement rates for procedures such as knee arthroscopy, osteosynthesis of the hand, and carpal tunnel decompression when compared with other published studies, which have reported rates of up to 83.1, 70.7, and 64.3 %, respectively [19]. As in other articles [15][16][17], pain and bleeding are still the most common reasons for adverse events after ambulatory surgical procedures. In our experience, most of the patients who needed unexpected overnight admission or readmission during the first 24 h after surgery were of advanced age, had an ASA status of III, or had undergone a lengthy surgery.…”

Section: Discussionsupporting

confidence: 75%

“…Quality of care was evaluated based on the rates of unplanned overnight admission, patient returns to hospital within 24 h, admission within 24 h and during the first month after surgery, and cancellation of booked procedures. Those outcomes were lower than seen in other studies of ambulatory surgery overall [14][15][16][17]. In this respect, the data provided by Matilla et al [18], after a thorough study of day surgery of all specialties in Finland, revealed rates of admission of 5.9 % and readmission within 24 h postoperatively of 0.1 %.…”

Section: Discussionmentioning

confidence: 76%

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Ambulatory surgery in orthopedics: experience of over 10,000 patients

Martín-Ferrero

Faour-Martín

Simón-Pérez

et al. 2014

Journal of Orthopaedic Science

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 76%

Ambulatory surgery in orthopedics: experience of over 10,000 patients

Martín-Ferrero

Faour-Martín

Simón-Pérez

et al. 2014

Journal of Orthopaedic Science

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“…14,15,[17][18][19][20] The frequency of postoperative ORADEs also poses a significant economic burden and strain on resources to hospitals and health care providers. For example, respiratory depression and nausea/vomiting require increased monitoring by the nursing staff and increased utilization of supportive care therapies such as antiemetics.…”

Section: Study Design and Sample Selectionmentioning

confidence: 99%

Development and Validation of a Risk Score to Identify Patients at High Risk for Opioid-Related Adverse Drug Events

Minkowitz¹,

Scranton

Gruschkus

et al. 2014

JMCP

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BACKGROUND: Opioid-related adverse drug events (ORADEs) are common causes of hospitalization and increased health care costs. OBJECTIVES: To (a) estimate rates of specific adverse drug events (ADEs) among gastrointestinal (GI) surgery patients receiving postoperative opioids; (b) examine the utility of a risk-scoring model in categorizing patients at high risk of experiencing ORADEs; and (c) quantify potential clinical/economic benefits of targeting high-risk GI surgical patients for opioid-sparing regimens in terms of hospitalization cost, length of stay (LOS), and 30-day readmission rates. METHODS: Using a retrospective design based on an administrative database, patients with an inpatient surgical procedure between January 1, 2010, and December 31, 2010, were included. GI surgical patients aged > 18 years followed from admission through 30 days postdischarge were characterized as high or low risk using clinical/demographic characteristics and were evaluated for several outcomes. Using multivariate logistic regression, the ORADE incidence, total hospitalization cost, LOS, and 30-day readmissions were compared for high-risk and low-risk patients. RESULTS: In 87.8% (n = 3,235) of the surgical population, there was a strong concordance between risk assignment and ORADE incidence. Among the remaining 12.2% (n = 449) of patients, 5.5% (n = 202) were low risk with an ORADE, and 6.7% (n = 247) were high risk without an ORADE. Overall, 20.6% (n = 344) of high-risk patients experienced ≥ 1 ORADE (mean cost: $31,988; LOS: 12.1 days) compared with only 5.3% (n = 107) of lowrisk patients (mean cost: $25,216; LOS: 8.0 days). High-risk patients had higher hospitalization costs and longer LOS than low-risk patients, respectively (mean cost: $19,234 vs. $13,036; mean LOS: 6.8 days vs. 3.3 days). These differences correspond to 47.0% higher costs for high-risk patients and an LOS approximately twice as long compared with low-risk patients. CONCLUSIONS: Patient clinical/demographic characteristics influence the risk of developing ORADEs. Risk assessment tools can effectively identify high-risk patients, thereby enabling interventions that can reduce ORADEs, decrease hospital costs, and improve postsurgical experiences for patients.

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“…3 Inadequate relief of pain after ambulatory surgery increases morbidity and health care costs and reduces patients' quality of life. 4,5 To improve postoperative pain relief, an integrative approach combining pharmacologic methods and various complementary nonpharmacologic analgesic techniques has been recommended. 6 Auricular acupuncture holds promise, as it is an easily performed technique that might be effective for treatment of both preoperative anxiety and postoperative pain in patients undergoing ambulatory surgery.…”

mentioning

confidence: 99%

Auricular acupuncture for pain relief after ambulatory knee surgery: a randomized trial

Usichenko¹,

Kuchling²,

Witstruck³

et al. 2007

Canadian Medical Association Journal

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A lmost 70% of operative procedures in North America are currently performed in an ambulatory setting.1 Despite advances in surgical techniques and modern methods of analgesia, 45% of patients suffer pain at home after ambulatory surgery, 2 and moderate to severe pain intensity at home is reported by 30% of ambulatory patients.3 Inadequate relief of pain after ambulatory surgery increases morbidity and health care costs and reduces patients' quality of life.4,5 To improve postoperative pain relief, an integrative approach combining pharmacologic methods and various complementary nonpharmacologic analgesic techniques has been recommended.6 Auricular acupuncture holds promise, as it is an easily performed technique that might be effective for treatment of both preoperative anxiety and postoperative pain in patients undergoing ambulatory surgery.7,8 However, there are reasonable doubts in the scientific community concerning the specificity of acupuncture, 9 because the large randomized trials on auricular acupuncture for treatment of cocaine and alcohol dependence have found no difference between treatment and invasive needle control. 10,11Thus, after refining the methodology in a pilot study, 12 we performed a randomized controlled trial to compare the postoperative analgesic effect of auricular acupuncture with invasive needle control in patients after ambulatory knee surgery. MethodsThis prospective, patient-and evaluator-blinded, controlled study was performed between August 2003 and September 2004 at the Ambulatory Orthopedic Surgery Center of the Ernst Moritz Arndt University, Greifswald, Germany. The study was approved by the university's ethics committee. Consecutive patients scheduled for arthroscopic ambulatory knee surgery under general anesthesia (without premedication) were enrolled in the study. Exclusion criteria were age younger than 18 years or older than 70 years; American Society of Anesthesiologists physical status III (severe systemic disease with functional limitation); history of opioid, sedative or hypnotic medication or excess alcohol use; inability to understand the consent form or how to use a visual analogue scale for pain measurement; local auricular infection or significant auricular deformation; or presence of prosthetic cardiac valves. Patients were withdrawn from the study if it was necessary to change the perioperative analgesia scheme, if the arthroscopic procedure was turned into open knee surgery or if the patient was unexpectedly admitted to hospital after the procedure.On the day before surgery the patients were told that they would receive auricular acupuncture at specific points or Auricular acupuncture for pain relief after ambulatory knee surgery: a randomized trial Background: Auricular acupuncture is a promising method for postoperative pain relief. However, there is no evidence for its use after ambulatory surgery. Our aim was to test whether auricular acupuncture is better than invasive needle control for complementary analgesia after ambulatory knee surgery. Methods:O...

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Retrospective evaluation of unanticipated admissions and readmissions after same day surgery and associated costs

Cited by 317 publications

References 9 publications

Ambulatory surgery in orthopedics: experience of over 10,000 patients

Ambulatory surgery in orthopedics: experience of over 10,000 patients

Development and Validation of a Risk Score to Identify Patients at High Risk for Opioid-Related Adverse Drug Events

Auricular acupuncture for pain relief after ambulatory knee surgery: a randomized trial

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