Adverse Events in Infants Less Than 6 Months of Age After Ambulatory Surgery and Diagnostic Imaging Requiring Anesthesia

Abstract

Introduction: AAP guidelines recommend infants less than 6 months of age are monitored for at least 2 hours following surgery. This retrospective study evaluated if adherence to the 2-hour monitoring guideline decreased the risk of adverse events associated with ambulatory procedures in infants younger than 6 months. Methods: We queried the hospital’s electronic medical record to identify patients younger than 6 months of age who received anesthetic care from January 2015 to March 2020. Demographic data, intraoperative adverse events, and returns to the emergency department (ED) or urgent care within 7 days were captured for each patient. We calculated the number and frequency for categorical data and median and interquartile range (IQR) for continuous data. Chi-square or Fisher’s exact test were used to compare patients who experienced an adverse event to those that did not. Results: One thousand one hundred seventy-seven patients who had 1,261 unique anesthetic encounters were analyzed. Forty-four adverse events were identified, 20 (1.6%) before discharge, including 3 unplanned admissions, and 24 (1.9%) returns to the ED/UC within 7 days postoperatively. We did not observe differences in postoperative recovery time in patients who experienced an adverse event and those who did not (88 min vs. 77 min, respectively, P = 0.078). None of the ED/UC returns would have been avoided by a longer PACU stay. Conclusions: With the appropriate patient selection, once physiological discharge readiness is met, adherence to a strict 2-hour time-based discharge criteria does not increase safety for infants younger than 6 months of age after ambulatory procedures.

Day-case surgery patient selection and discharge criteria in children

“…The day-surgery unit should not be considered a "step-down" unit for minor surgery on minors. [11,25,30,31] Family DCS does not suit the social circumstances of all children and their families. Pre-anesthetic assessment is an opportunity to assess information about the child, home circumstances, and parents/care takers, to establish who has parental responsibility and to ensure that appropriate consent procedures are followed.…”

“…Special exceptions may be made at the discretion of the anesthetist, surgeon, or senior nursing staff for patients who would benefit from being discharged home earlier than usual, including patients with disabilities or special needs (e.g., Autism) and patients undergoing a short procedure (e.g., catheter removal). [25][26][27][28][29][30][31][32][33] 1. Patient care can be provided equally well at home as at the hospital.…”