Readmission and overstay after day case nasal surgery

Abstract

BackgroundA readmission is classified as a patient necessitating readmission to hospital due to a post-operative complication following discharge. An overstay however, is classified as a patient having to stay longer than the planned duration in hospital (not having been discharged in the interim) due to a post-operative complication. This study aims to investigate patient-related factors that predispose to readmission or overstay and thus make recommendations to decrease the likelihood of readmission or overstay.MethodIn this retrospective study 312 'day-case nasal procedures', were selected from a total cohort of 4274 ENT patients over a 17-month period. This sub-group was investigated for a range of demographic factors including, age, gender and ethnicity with regards to their relationship to readmission rates and overstay frequency and duration.ResultsThe rates were 2.88% and 9.62% for readmission and overstay respectively. The total number of days spent in hospital as a result of readmission was 27. Epistaxis was the leading cause for readmission/overstay (28.9%) followed by high levels of post-operative pain preventing them from being discharged (23.7%). All procedures in this study had readmission rates that were below those recommended in the guidelines set by the Royal College of Surgeons of England. Women overstayed significantly longer (t = 1.65, p < 0.05) than men.ConclusionsSuitable candidates for day-case ENT surgery highlighted by this study include healthy individuals between the ages of 20 and 60. Operating in the morning would increase the immediate post-operative recovery time, which may reduce the numbers of patients who complain of high levels of pain at the time of discharge. Procedures such as septorhinoplasty being performed routinely in the ambulatory setting require additional research into more effective methods of pain control. Standards need to be improved so that the causes of overstay and readmission are clearly identifiable in patient records.

Intranasal lidocaine plus naphazoline nitrate improves surgical conditions and perioperative analgesia in septorhinoplasty surgery

“…The leading causes for these events included postoperative pain and bleeding. Similarly, Singh et al 2 reported that 24% of patients had unacceptable levels of postoperative pain, delaying their hospital discharge. In our study, the VAS pain scores in the lidocaine group were very low throughout the 24-h study period, and no patient required rescue analgesia.…”

“…1 The leading causes of hospital readmission and/or overstay after day-care septorhinoplasty surgery are epistaxis and a high level of postoperative pain. 2 A multimodal analgesia regimen can be used, but many patients suffer from adverse events after opioid administration. 3,4 Also, the use of high doses of nonsteroidal anti-inflammatory drugs is associated with patient readmission after septorhinoplasty surgery.…”

Pain Treatment and Recovery After Endoscopic Sinus Surgery

“…First, pain is the most important cause for delayed return to normal daily activities and work after routine ENT surgery 4 . Second, postoperative pain is an important cause for readmission after day‐case nasal surgery 5 . Third, ESS is commonly performed on a day‐case basis, which needs to be based on an effective and feasible pain treatment regimen, because after discharge patients themselves are responsible for their own pain management.…”

“…4 Second, postoperative pain is an important cause for readmission after day-case nasal surgery. 5 Third, ESS is commonly performed on a day-case basis, which needs to be based on an effective and feasible pain treatment regimen, because after discharge patients themselves are responsible for their own pain management. Finally, untreated pain can cause avoidable expenditures to the patients and their employers, and to the health care system.…”

Perioperative analgesia for patients undergoing endoscopic sinus surgery: an evidence‐based review

“…Hence, recent years have witnessed renewed interest in delineating optimal perioperative analgesic regimens, as the possibility of pain has been cited as a potential barrier for the decision to proceed with surgery . Moreover, there has been increased cognizance of the role prescription drugs play in the opioid “crisis” and the deleterious impact insufficient pain control may have on healthcare costs, as inadequate analgesia may lead to readmission after nasal surgery . In our contemporary healthcare environment, typified by increasing recognition of the impact of interventions on healthcare utilization, evidence‐based reviews provide important clinical guidance.…”