Unplanned hospital admission after ambulatory surgery: a retrospective, single cohort study
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Unplanned hospital admission after ambulatory surgery: a retrospective, single cohort study Admission non planifie´e a` l’hoˆpital apre`s une chirurgie ambulatoire : une e´tude re´trospective de cohorte unique . Yi-Ju Li, PhD . Richard Pollard, MD . Zhengxi Chen . M. Stephen Melton, MD John Hunting . Thomas Hopkins, MD . William Buhrman, MD . Brad Taicher, DO . Solomon Aronson, MD . Mark Stafford-Smith, MD . Karthik Raghunathan, MBBS, MPH Received: 26 April 2019 / Revised: 10 July 2020 / Accepted: 12 July 2020 Ó Canadian Anesthesiologists’ Society 2020
Abstract Purpose We estimated the rate of unplanned hospital and intensive care unit (ICU) admissions following ambulatory surgery centre (ASC) procedures, and identified factors associated with their occurrence. Methods This retrospective cohort included adult patients who underwent ASC procedures within a large community practice from January 2010 to December 2014. Patients were categorized into two groups: unplanned postoperative hospital/ICU admission within 24 hr of procedure or uneventful discharge. Demographics, comorbidities,
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12630-020-01822-1) contains supplementary material, which is available to authorized users. M. S. Melton, MD (&) J. Hunting T. Hopkins, MD W. Buhrman, MD B. Taicher, DO S. Aronson, MD M. Stafford-Smith, MD Department of Anesthesiology, Duke University Medical Center, DUMC, Box #3094, Stop# 4, Durham, NC 27110, USA e-mail: [email protected] Y.-J. Li, PhD Z. Chen Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA R. Pollard, MD American Anesthesiology, Durham, USA K. Raghunathan, MBBS, MPH Department of Anesthesiology, Duke University Medical Center, DUMC, Box #3094, Stop# 4, Durham, NC 27110, USA CAPER Unit, Duke Anesthesiology, Durham, NC, USA
anesthesia type, procedure type, procedure group, and ASC facility were assessed. Results Of the 211,389 patients included, there were 211,147 uneventful discharges (99.89%) and 242 unplanned hospital admissions (0.11%), of which 75 were ICU admissions (0.04%). The multivariable logistic regression model for hospital admission showed an increased risk associated with age [ 50 yr (odds ratio [OR], 1.53); American Society of Anesthesiologists (ASA) physical status (III vs II: OR, 1.45; IV vs II: OR, 1.88), comorbidity (chronic obstructive pulmonary disease: OR, 2.63; diabetes mellitus: OR, 1.62; transient ischemic attack: OR, 2.48) procedure (respiratory: OR, 2.92; digestive: OR, 2.66; musculoskeletal system: OR, 2.53), anesthetic management (general anesthesia [GA] and peripheral nerve block vs GA: OR, 1.79), and ASC facility (189BB: OR, 2.29; 30E9A: OR, 7.41; and BD21F: OR, 1.69). The multivariable logistic regression model for ICU admission showed increased risk of unplanned ICU admission associated with ASA physical status (ASA III vs II: OR, 3.0; ASA IV vs II: OR, 8.52), procedure (musculoskeletal syst
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