Outcomes in day surgery

Shnaider, Ilia; Chung, Frances

doi:10.1097/aco.0b013e328010107e

Cited by 113 publications

(101 citation statements)

References 65 publications

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“…These rates are consistent with other studies (7)(8)(9). The rate of mortality associated with anesthesia and surgery in the outpatient setting has been estimated to be 0.25 to 0.50 per 100,000 outpatient procedures (7,9). As expected, no deaths were identified in the present study (mean patients age 35 yrs).…”

Section: Commentssupporting

confidence: 93%

Adverse events and readmissions after day-case urological surgery

et al. 2007

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Objective: The literature lacks of studies on postoperative outcomes after urological ambulatory surgery. Our study aims to identify parameters associated with postoperative complications within 30 days after ambulatory urological surgery. Materials and Methods: Adjusted and unadjusted comparisons between clinical features and postoperative outcome (complicated and uncomplicated).Results: Postoperative course was complicated in 5% of the patients. Discharge schedule was not completed in 1.1% while unplanned visits resulted in admission in 0.5%. Multivariate analyses could only confirm the independent effect of type of anesthesia and diagnosis-related group (DRG) relative weight. Conclusions: Ambulatory urological surgery can be safe in terms of postoperative complications. In the present study surgery under general anesthesia, or a higher DRG relative weight procedure, increased the risk of complications compared to surgery under regional or local anesthesia or lower DRG relative weight operations. Patients scheduled for general anesthesia or undergoing complex urological procedures should be warned about an increased risk of postoperative incidents and/or readmission.

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Section: Commentssupporting

confidence: 93%

Adverse events and readmissions after day-case urological surgery

et al. 2007

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“…We defined unanticipated admission as any patient admitted on the same day as their ambulatory procedure (even if the patient was discharged from the same day surgical unit).The candidate variables included those previously identified (surgical procedure, type of anesthesia, procedure duration, sex, ASA classification, late surgery). [4][5][6][7] Other clinically sensible conditions included Mallampati score, hospital site, pain (combination of opiate analgesics and chronic pain), BMI score, intraoperative events, psychiatric illness (combination of antidepressants, antipsychotics, anxiolytics, and psychiatric illness), dysrhythmia (combination of atrial fibrillation and dysrhythmia), congestive heart failure (combination of congestive heart failure and decreased left ventricular function), smoking, diabetes, hypertension, ischemic heart disease, sleep apnea, thyroid disease, asthma, stroke/transient ischemic attack, and gastroesophageal reflux disease. In addition, the impact of three interactions on unanticipated admission was assessed, i.e., the interaction between age and ASA score, type of surgery and site of surgery, and ASA score and intraoperative events.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5] Unanticipated admission has been suggested as such a marker as well as a way to identify unsuitable ambulatory surgical candidates. 6,7 Unanticipated admissions result in inflated costs to an already stressed healthcare system. 3,8 In the USA and the UK, the incidence of these unanticipated admissions ranges from 0.9-9.4%.…”

Section: Résumémentioning

confidence: 99%

Predictors of unanticipated admission following ambulatory surgery: a retrospective case-control study

Whippey

Kostandoff

Paul

et al. 2013

Can J Anesth/J Can Anesth

100

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Purpose The primary objectives of this historical casecontrol study were to evaluate the incidence of and reasons and risk factors for adult unanticipated admissions in three tertiary care Canadian hospitals following ambulatory surgery. Methods A random sample of 200 patients requiring admission (cases) and 200 patients not requiring admission (controls) was taken from 20,657 ambulatory procedures was identified and compared. The following variables were included: demographics, reason for admission, type of anesthesia, surgical procedure, length of procedure, American Society of Anesthesiologists' (ASA) classification, surgical completion time, pre-anesthesia clinic, medical history, medications (classes), and perioperative complications. Multiple logistic regression analysis was used to assess factors associated with unanticipated admissions. ResultsThe incidence of unanticipated admission following ambulatory surgery was 2.67%. The most common reasons for admission were surgical (40%), anesthetic (20%), and medical (19%). The following factors were found to be associated with an increased risk of unanticipated admission: length of surgery of one to three hours (odds ratio [OR] Author contributions Amanda Whippey, Greg Kostandoff, James Paul, Jinhui Ma, and Lehana Thabane helped design the study and write the manuscript. Amanda Whippey, Greg Kostandoff, and James Paul helped conduct the study. Heung Kan Ma helped in data collection, and Jinhui Ma and Lehana Thabane helped analyze the data. James Paul is the author responsible for archiving the study files. Amanda Whippey, Greg Kostandoff, Jinhui Ma, James Paul, Lehana Thabane, and Heung Kan Ma have seen the original study data. Amanda Whippey, Greg Kostandoff, Jinhui Ma, James Paul, and Lehana Thabane reviewed the analysis of the data. 0.08 to 0.33), and dental/ear-nose-throat surgery (OR 0.32; 95% CI 0.13 to 0.83) when compared with general surgery. Other comorbid conditions did not impact unanticipated admission. Conclusion Unanticipated admission after ambulatory surgery occurs mainly due to surgical, anesthetic, and medical complications. Length of surgery more than one hour, high ASA class, advanced age, and increased BMI were all predictors. No specific comorbid illness was associated with an increased likelihood of unanticipated admission. These findings support continued use of the ASA classification as a marker of patient perioperative risk rather than attributing risk to a specific disease process. RésuméObjectif Les objectifs primaires de cette e´tude cas-te´moin historique e´taient d'e´valuer l'incidence ainsi que les raisons et les facteurs de risque des admissions non anticipe´es de patients adultes dans trois hôpitaux canadiens de soins tertiaires apre`s une chirurgie ambulatoire. dentaire / oto-rhino-larynge´e (ORL) (RC 0,32; IC 95 % 0,13 a`0,83) par rapport a`une chirurgie ge´ne´rale. Aucun impact sur les admissions non anticipe´es n'a e´te´observeá vec d'autres comorbidite´s. Conclusion Les admissions non anticipe´es apre`s une chi...

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“…9 Degree of satisfaction was the patient's reaction to the healthcare received. 11 Postoperative cognitive dysfunction was a state of mental confusion after orthopedic surgery. Blood transfusion requirement was considered to be the number of blood units transfused.…”

Section: Discussionmentioning

confidence: 99%

Neuraxial anesthesia for orthopedic surgery: systematic review and meta-analysis of randomized clinical trials

2013

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CONTEXT AND OBJECTIVE: Taking the outcome of mortality into consideration, there is controversy about the beneficial effects of neuraxial anesthesia for orthopedic surgery. SciELO, EMBASE (1974 to November 2012 and reference lists of the studies included. Only randomized controlled trials were included. RESULTS: Out of 5,032 titles and abstracts, 17 studies were included. There were no statistically significant differences in mortality (risk difference, RD: -0.01; 95% confidence interval, CI: -0.04 to 0.01; n = 1903), stroke (RD: 0.02; 95% CI: -0.04 to 0.08; n = 259), myocardial infarction (RD: -0.01; 95% CI: -0.04 to 0.02; n = 291), length of hospitalization (mean difference, -0.05; 95% CI: -0.69 to 0.58; n = 870), postoperative cognitive dysfunction (RD: 0.00; 95% CI: -0.04 to 0.05; n = 479) or pneumonia (odds ratio, 0.61; 95% CI: 0.25 to 1.49; n = 167). CONCLUSION: So far, the evidence available from the studies included is insufficient to prove that neuraxial anesthesia is more effective and safer than general anesthesia for orthopedic surgery. However, this systematic review does not rule out clinically important differences with regard to mortality, stroke, myocardial infarction, length of hospitalization, postoperative cognitive dysfunction or pneumonia. CONCLUSÃO: Até o momento, as evidências são insuficientes nos estudos incluídos para provar que AN é mais efetiva e segura do que AG para cirurgias ortopédicas. Esta revisão sistemática não descartou diferenças clínicas importantes para mortalidade, acidente vascular encefálico, infarto miocárdico, tempo de internação, disfunção cognitiva pós-operatória e pneumonia. RESUMO IMSc. Professor,

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Outcomes in day surgery

Abstract: Ambulatory surgery, as currently practiced, provides quality care that is cost-effective. Minor adverse events such as pain and postoperative nausea and vomiting are still common, and improvement could be targeted in these areas.

Cited by 113 publications

References 65 publications

Adverse events and readmissions after day-case urological surgery

Adverse events and readmissions after day-case urological surgery

Predictors of unanticipated admission following ambulatory surgery: a retrospective case-control study

Neuraxial anesthesia for orthopedic surgery: systematic review and meta-analysis of randomized clinical trials

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