Age as a Predictive Factor for In-Patient Admission Following Day-Case Shoulder Arthroscopic Sub-Acromial Decompression – A District General Hospital Audit

Abstract

Ann R Coll Surg Engl 2008; 90: 62-64 62Day-case surgery has become more popular in recent times. It benefits the patient as no stay in hospital is required enabling recovery at home with family and friends and, most importantly, decreases the risk of nosocomial infection.1 Day-case surgery also carries benefits to the health service as it reduces pressure on in-patient beds and eliminates the cost of an overnight admission. One risk of day-case surgery is in-patient admission following the operation. One factor necessitating an overnight admission is severe postoperative pain. Such a change in plan can be disruptive to both the patient, who was psychologically prepared to return home, and the hospital that will be required to allocate a bed to that patient at short notice. [4][5][6][7] Significant co-morbid factors such as high body mass index, hypertension and ischaemic heart disease adversely affect overall suitability for day-case surgery. The purpose of this study was to identify any factors predictive of in-patient admission following arthroscopic sub-acromial decompression (ASAD) of the shoulder planned as a day-case procedure. Patients and MethodsA retrospective review was performed at the Day Surgical Unit (DSU) of the Royal Hampshire County Hospital, Winchester, UK. Over a 2-year period (June 2002 to June 2004), 27 day-case ASAD procedures were performed in 27 patients in the DSU. These would have previously been performed as an in-patient.All operations were performed under general anaesthesia without regional block anaesthesia but with local anaesthetic infiltration at the end of the procedure (20 ml 0.5% chirocaine). The postoperative analgesia was standardised with patients being given co-dydramol and diclofenac upon discharge from the DSU. Three patients did not receive diclofenac due to drug sensitivity. Admission following day-case surgery can be problematic for both the patient and the health service. The purpose of this study was to identify any factors predictive of admission following arthroscopic sub-acromial decompression (ASAD) of the shoulder planned as day-case procedures.

Outpatient Gastroplasty for Morbid Obesity: Our First Hundred Cases

“…Although medical and social problems increase with age, there are no arbitrary upper age limits for day surgery. However, previous studies on different types of ambulatory procedures have already shown that elevated age was a significant predictor for unplanned admission [10,11]. We found a higher BMI also to be a key factor in failure of outpatient procedure.…”

Risk Factors for Hospital Admission Following Arthroscopic Bankart Repair

“…Overall, 39% anticipated admission for pain control; 67% of patients older than 55 years vs only 11% of patients younger than 55 years expected admission. 25 This once again highlights the importance of patient expectations in the preoperative setting. Additional time taken during the preoperative evaluation to educate patients regarding their postoperative course can lead to unnecessary admission being avoided and patient satisfaction being improved.…”

“…8,23 Cullen at al 24 found that age was a significant predictor for unexpected intensive care admission following any inpatient surgery among more than 17,000 patients. Jain et al 25 surveyed patients scheduled to undergo arthroscopic subacromial decompression to assess their expectation for admission following surgery. Overall, 39% anticipated admission for pain control; 67% of patients older than 55 years vs only 11% of patients younger than 55 years expected admission.…”

Preoperative screening, evaluation, and optimization of the patient's medical status before outpatient surgery

“…For patients with scores of four or higher, the odds ratio was 31.96 (95% CI 26.29-38.86) and 2.8% of these patients required admission. A study from the United Kingdom identified age as a predictor of postoperative admission for pain control after day-case arthroscopic shoulder surgery [38]. Age at least 50 years adversely affected the same-day discharge of patients having laparoscopic cholecystectomies [39].…”