Unanticipated Admission to the Hospital Following Ambulatory Surgery

Gold, B.; Kitz, D S; Lecky, John; Neuhaus, John

doi:10.1001/jama.1989.03430210050028

Cited by 486 publications

(57 citation statements)

References 10 publications

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“…5,6,10,14 In one seminal study the odds ratio for unplanned admission due to vomiting after outpatient surgery was an alarmingly high 3.4 (95% CI 1.8–6.4); patients were readmitted only slightly more frequently for pain or bleeding than for emesis. 10 …”

Section: Introductionmentioning

confidence: 99%

Multimodal Protocol Reduces Postoperative Nausea and Vomiting in Patients Undergoing Le Fort I Osteotomy

Brookes

Berry

Rich

et al. 2015

Journal of Oral and Maxillofacial Surgery

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Purpose-To assess the impact of a multimodal antiemetic protocol on postoperative nausea and vomiting (PONV) after LeFort I osteotomy.Methods-Consecutive subjects undergoing LeFort I osteotomy with or without additional procedures at a single academic institution were recruited as the intervention cohort for an IRBapproved prospective clinical trial with a retrospective comparison group. The intervention cohort was managed with a multimodal antiemetic protocol including total intravenous anesthesia; prophylactic ondansetron, steroids, scopolamine, and droperidol; gastric decompression at surgery end; opioid-sparing analgesia; avoidance of morphine and codeine; prokinetic erythromycin; and minimum 25 mL/kg fluids. The comparison group consisted of consecutive subjects from a larger study who underwent similar surgical procedures prior to protocol implementation. Data including Please address correspondence to: Dr. Jay Anderson, 101 Manning Dr CB 7450, Chapel Hill, NC 27599, janderson@aims.unc.edu, 919.537.3721 phone, 919.537.3407 fax. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Results-The intervention (n=93) and comparison (n=137) groups were similar in terms of gender (58% and 65% female, P=0.29), race (72% and 71% Caucasian, P=0.85), age (median 19 and 20 years old, P=0.75), proportion of subjects with known risk factors for PONV (P=0.34), percentage undergoing bimaxillary surgery (60% for both groups), and percentage for whom surgery time was over 180 minutes (63% versus 59%, P=0.51). NIH Public AccessPrevalence of PON was significantly lower in the intervention group than the comparison group (24% versus 70%, P<0.0001). Prevalence of POV was likewise significantly lower in the intervention group (11% versus 28%, P=0.0013). The likelihood that subjects in the comparison group would experience nausea was 8.9 and vomiting 3.7 times higher than in the intervention group.Conclusion-This multimodal protocol was associated with substantially decreased prevalence of PONV in subjects undergoing LeFort I osteotomy.

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Section: Introductionmentioning

confidence: 99%

Multimodal Protocol Reduces Postoperative Nausea and Vomiting in Patients Undergoing Le Fort I Osteotomy

Brookes

Berry

Rich

et al. 2015

Journal of Oral and Maxillofacial Surgery

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“…PONV causes patient discomfort and can lead to prolonged stay in the post-anesthesia care unit (PACU). Patients with PONV are also predisposed to complications of dehydration, electrolyte imbalance, aspiration pneumonia, increased wound dehiscence, delayed recovery, prolonged hospital stay, and increased medical cost 5-8. Accordingly, anesthesiologists should give attention to preventing PONV in patients undergoing RLRP, because the RLRP itself can be an important risk factor for PONV, although most patients involve fewer patient-related risk factors 5,9…”

Section: Introductionmentioning

confidence: 99%

Total Intravenous Anesthesia with Propofol Reduces Postoperative Nausea and Vomiting in Patients Undergoing Robot-Assisted Laparoscopic Radical Prostatectomy: A Prospective Randomized Trial

et al. 2012

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PurposeWe investigated the effect of total intravenous anesthesia (TIVA) with propofol on postoperative nausea and vomiting (PONV) after robot-assisted laparoscopic radical prostatectomy (RLRP) in patients at low risk of developing PONV, in comparison to balanced anesthesia with desflurane.Materials and MethodsSixty two patients were randomly assigned to the Des or TIVA group. Propofol and remifentanil were used for induction of anesthesia in both groups and for maintenance of the anesthesia in the TIVA group. In the Des group, anesthesia was maintained with desflurane and remifentanil. In both groups, postoperative pain was controlled using fentanyl-based intravenous patient controlled analgesia, and ramosetron 0.3 mg was administered at the end of surgery. The incidence of PONV, severity of nausea and pain, and requirements of rescue antiemetics and analgesics were recorded.ResultsThe incidence of nausea in the post-anesthetic care unit was 22.6% in the Des group and 6.5% in the TIVA (p=0.001) group. The incidence of nausea at postoperative 1-6 hours was 54.8% in the Des group and 16.1% in the TIVA group (p=0.001). At postoperative 6-48 hours, there were no significant differences in the incidence of nausea between groups.ConclusionIn order to prevent PONV after RLRP in the early postoperative period, anesthesia using TIVA with propofol is required regardless of patient-related risk factors.

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“…The incidence of unanticipated admission in this study was 4.51% that compares favourably with other published reports, which document rates between 1.04% and 5.4%. [2456789101112] Patients were admitted for an average of 4.5 days however 70% of patients were admitted only for 1 day.…”

Section: Discussionmentioning

confidence: 99%

A nested case-control study to determine the incidence and factors associated with unanticipated admissions following day care surgery

Singh¹,

Ponniah²,

Jacob³

2016

Indian J Anaesth

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Background and Aims:Day care surgery offers respite from hospitalisation for specific surgical procedures and has many advantages. However, occasionally patients who undergo such surgery require hospitalisation for unanticipated complications. We aimed to determine their incidence and to identify factors associated with unanticipated admissions in a tertiary care hospital in South India.Methods:During the 3-month study, 63 cases requiring admission and 126 randomly selected controls were taken from the 776 procedures that were performed were compared. The variables studied were patients’ demographic characteristics, pre-operative medical illness, personal habits, American Society of Anesthesiologists status, the diagnosis and surgical procedures, time since last meal, duration of anaesthesia and surgery, experience of the surgeon and anaesthetist, and intraoperative management (techniques, drugs, monitoring, etc.). Univariate and bivariate statistics were used to determine factors associated with unanticipated admissions.Results:The incidence of unanticipated admissions following day care surgery was 8.11%. The reasons for admission were anaesthetic (33.33%), surgical (15.87%), medical (6.34%) and social (44.44%). The factors significantly associated with unanticipated admissions included duration of anaesthesia more than 50 min (odds ratio [OR]: 3.179; 95% confidence interval [CI]: 1.503–6.722), and starting the last case after 3 pm (OR: 10.095; 95% CI: 2.418–42.148).Conclusion:Unanticipated admissions following day care surgery occur mainly due to anaesthetic, surgical, medical and social reasons.

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Unanticipated Admission to the Hospital Following Ambulatory Surgery

Cited by 486 publications

References 10 publications

Multimodal Protocol Reduces Postoperative Nausea and Vomiting in Patients Undergoing Le Fort I Osteotomy

Multimodal Protocol Reduces Postoperative Nausea and Vomiting in Patients Undergoing Le Fort I Osteotomy

Total Intravenous Anesthesia with Propofol Reduces Postoperative Nausea and Vomiting in Patients Undergoing Robot-Assisted Laparoscopic Radical Prostatectomy: A Prospective Randomized Trial

A nested case-control study to determine the incidence and factors associated with unanticipated admissions following day care surgery

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