Impact of ambulatory surgery day of the week on postoperative outcomes: a population-based cohort study

Abstract

Purpose Ambulatory surgery is generally considered safe; however, as many as 3% of patients require unplanned acute postoperative care. The purpose of this study was to measure the impact of the day of the week of surgery on the outcomes of ambulatory surgery. Methods Using population-based health administrative data, we conducted a historical cohort analysis by identifying patients who underwent ambulatory surgery from 2002-2012. Multivariable regression was used to measure the association between the day of the week of surgery and the primary outcomes of 30-day emergency department (ED) visit or hospital readmission after successful discharge on the day of surgery. The secondary outcome that was similarly compared was unsuccessful discharge on the day of surgery. Results Of 296,497 patients identified, 32,100 (10.5%) returned to the ED or were readmitted to hospital within 30 days. Adjusting for demographics, comorbidities, and preoperative use of health resources, Friday surgery was most associated with the primary outcome (adjusted hazard ratio, 1.07; 95% confidence interval, 1.03 to 1.11) when compared with Monday surgery. This association was stronger in certain surgery types. There were 9,197 (3.1%) patients who were not discharged on the day of surgery; no association between day of the week and unsuccessful discharge was identified. Conclusion On a population level, there was a small effect of the day of the week of ambulatory surgery on outcomes; however, the clinical impact is likely not relevant. Certain surgical types may be more susceptible to a day of the week effect, but more research is needed to elucidate this notion. RésuméObjectif En règle générale, les chirurgies ambulatoires sont considérées comme étant sécuritaires; toutefois, jusqu'à 3 % des patients nécessitent des soins postopératoires aigus non planifiés. L'objectif de cette étude était de mesurer l'impact du jour de la semaine durant lequel la chirurgie a eu lieu sur les pronostics de chirurgie ambulatoire. Méthode À l'aide des données administratives de santé basées sur la population, nous avons réalisé une analyse de cohorte historique en identifiant les patients ayant subi une chirurgie ambulatoire entre 2002 et 2012. Nous avons utilisé une analyse par régression multivariée pour mesurer l'association entre le jour de la semaine au

Peripheral Nerve Blocks for Ambulatory Shoulder Surgery

“…Participants were identified using the Same Day Surgery Database through application of previously studied Canadian Classification of Interventions codes to identify the following shoulder surgeries: rotator cuff repair, shoulder arthroplasty or joint repair, and other repair of shoulder muscles (see specific codes in Supplemental Digital Content, appendix 1, http://links.lww.com/ALN/B993). 7 We compiled a patient-level cohort by including only the first surgery for any participant in the study period. exposure Our primary exposure was receipt of a nerve block.…”

“…3,4 However, despite low incidence of serious complications after ambulatory surgery, 5 more than 3% of patients require unplanned hospital admission on the day of surgery, 6 and more than 10% of patients have an emergency department visit in the 30 days after surgery. 7 Evidence suggest that more than 25% of unanticipated admissions after ambulatory surgery are attributable to anesthesiology care and interventions. 8 Variations in perioperative anesthesia care for shoulder surgery have been documented.…”

Association of peripheral nerve blocks with postoperative outcomes in ambulatory shoulder surgery patients: a single-centre matched-cohort study

“…Participants were identified through the NACRS using previously studied Canadian Classification of Interventions (CCI) codes to identify the following shoulder surgeries: shoulder arthroscopy, arthroplasty synthetic repair, implantation of an internal device shoulder joint, repair of recurrent dislocation, other shoulder repair, shoulder arthrotomy, division of joint capsule, lining or cartilage shoulder, synovectomy shoulder, other local excision, destruction of shoulder joint, or other joint excision (shoulder) (Appendix A, available as Electronic Supplementary Material [ESM]). 10 We compiled a patient-level analysis cohort by including only the first surgery for any participant in the study period. Our start time of January 1, 2011 was chosen to coincide with the system-wide introduction of SIMS.…”

In Reply to “Letter to the Editor: Surgical Start Times and Outcomes: It’s Not Just the Hour, but the Day as Well”

“…3 Furthermore, a large historical cohort analysis that examined the association of day of the week of ambulatory surgical procedures found an adjusted hazard ratio of 1.07 (95% confidence interval 1.03-1.11) for the primary outcome of a 30-day emergency department visit or hospital re-admission, although no association was found for the secondary outcome of unsuccessful discharge on the day of the procedure. 4 A postulated explanation for the increase in emergency department visits after a Friday surgery was increased difficulty or inability to reach the surgeon or their office over the weekend as compared to during the week after a Monday procedure. Though this is unlikely to be the case in the realm of cardiac surgery, which typically involves intensive care in the immediate postoperative period and continous in-hospital availability, there certainly may be variations in staffing levels over the weekend that could lead to effects upon postoperative care of cardiac surgery patients.…”