Unplanned admission rates and postdischarge complications in patients over the age of 70 following day case surgery

Aldwinckle, Robin; Montgomery, J. E.

doi:10.1111/j.1365-2044.2004.03560.x

Cited by 50 publications

(41 citation statements)

References 3 publications

(5 reference statements)

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“…Our reported rate of unplanned admission in patients with a PSG (6.2%; 95% CI 5.0 to 7.4) was higher than in our general ambulatory population (2.1%; 95% CI 1.9 to 2.2) and higher than rates published from other ambulatory care centres. [17][18][19] It is unclear why patients who had previously undergone a PSG would be admitted more frequently than those who had not been tested. A review of Table 3 suggests that indications for unplanned admission were predominantly surgical or related to oxygen saturation.…”

Section: Discussionmentioning

confidence: 99%

Unplanned admission after day surgery: A historical cohort study in patients with obstructive sleep apnea

Bryson

Gómez

Jee

et al. 2012

Can J Anesth/J Can Anesth

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Section: Discussionmentioning

confidence: 99%

Unplanned admission after day surgery: A historical cohort study in patients with obstructive sleep apnea

Bryson

Gómez

Jee

et al. 2012

Can J Anesth/J Can Anesth

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“…There is good evidence to suggest the age is not a barrier to day case surgery. 27 It is still important to consider any potential comorbidities particularly common in increasing age. Although we excluded women with ASA grade III or IV, it has been suggested that women with ASA III could be safely treated as day cases.…”

Section: Discussionmentioning

confidence: 99%

A prospective observational study of the safety and acceptability of vaginal hysterectomy performed in a 24‐hour day case surgery setting

Penketh

Griffiths

Chawathe

2007

BJOG

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Objective To assess the safety and acceptability of vaginal hysterectomy with and without simultaneous oophorectomy in a 24-hour day case surgery setting for women with nonprolapse indications for surgery.Design Prospective observational study.Setting A busy teaching hospital and tertiary referral centre for Obstetrics and Gynaecology.Population Seventy-one women from one consultant's practice underwent a vaginal hysterectomy with a planned discharge within 24 hours after the procedure. All women had a body mass index less than 40 and a suitable home environment for routine day case surgery, other than that the women were from an unselected population.Method Prospective observational study.Main outcome measures The duration of the operation and mean blood loss were recorded. Any intraoperative complications were noted. In addition, the proportion of women discharged home within 24 hours of the operation was recorded together with any readmissions to hospital. Returns to theatres and any postoperative complications were also recorded. Postoperative pain scores were assessed 6 and 24 hours after procedure in selected women.Results Seventy-one vaginal hysterectomies were performed as 24-hour day case procedures. The intraoperative complication rate was 1.4%. Sixty-five women were discharged home within 24 hours (91.5%). The readmission rate within this group was 6.2%. The duration of the procedure, mean blood loss, return to theatre rate and incidence of febrile illness were comparable with rates recorded in inpatient studies.Conclusions Vaginal hysterectomy performed as a 24-hour day case procedure appears to be as safe as traditional inpatient management, with a high rate of early discharge and a low rate of readmission. This may have additional advantages for the woman and healthcare provider alike.

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“…Because day case surgery accounts for an increasing proportion of surgical workload in the elderly, 9 evidence of POCD immediately after surgery may have significant implications for their suitability for day surgery and postdischarge care. Propofol and sevoflurane are commonly used anesthetic agents in everyday practice.…”

Section: Conclusion : Le Premier Jour Après Une Opération Mineure L'mentioning

confidence: 99%

Increased incidence of postoperative cognitive dysfunction 24 hr after minor surgery in the elderly

Rohan

Buggy

Crowley

et al. 2005

Can J Anesth/J Can Anesth

109

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P Pu ur rp po os se e: : Postoperative cognitive dysfunction (POCD) is evident in 26% of elderly patients seven days after major non-cardiac surgery. Despite the growing popularity of day surgery, the influence of anesthetic techniques on next day POCD has not been investigated. Therefore, we evaluated the incidence of POCD and changes in serum markers of neuronal damage (S-100ß protein and Neuron-Specific Enolase), 24 hr after single-agent propofol or sevoflurane anesthesia in elderly patients undergoing minor surgery.M Me et th ho od ds s: : Patients (n = 30, mean age 73, range 65-86 yr) coming for cystoscopy or hysteroscopy, were randomized, in an observer-blind design, to receive either single-agent propofol or sevoflurane anesthesia. Changes in neuropsychological tests (the Stroop test and the modified Word-Recall Test), 24 hr postoperatively were compared with age-matched control subjects (n = 15) using Z-score analysis. Changes in S-100ß protein and NeuronSpecific Enolase levels were also documented.R Re es su ul lt ts s: : POCD was present in 7/15 [47% (95% confidence interval (CI) 21 to 72%)] patients who received propofol and 7/15 [47% (95% CI 21 to 72%)] patients who received sevoflurane, compared with 1/15 [7% (95% CI 6 to 19%)] control patients, P = 0.03. S-100ß protein and Neuron-Specific Enolase levels were not significantly different in anesthetized patients postoperatively compared with preoperative values. C Co on nc cl lu us si io on n: : The incidence of POCD in elderly patients on the first day after minor surgery is higher than previously reported for seven days after major surgery, and is increased after both propofol and sevoflurane anesthesia, compared with age-matched controls. S-100ß protein and Neuron-Specific Enolase levels were unaffected by anesthetic technique. Objectif : Le dysfonctionnement cognitif postopératoire (DCPO) se manifeste chez 26 % des patients âgés, sept jours après une opéra-tion non cardiaque majeure. Nous avons évalué l'incidence de DCPO et les modifications des marqueurs sériques d'atteinte neuronale (protéine S-100ß et énolase neurospécifique), 24 h après une anesthésie à un seul médicament, le propofol ou le sévoflurane, chez des patients âgés qui ont subi une opération mineure. Méthode : Les patients (n = 30, moyenne de 73 ans, limites de 65-86 ans) opérés pour cystoscopie ou hystéroscopie, ont été randomisés à l'insu d'un observateur pour une anesthésie avec propofol ou sévoflurane. Les changements aux tests neuropsychologiques (test Stroop, test modifié de remémoration de mots) ont été notés 24 h après l'opération et comparés à ceux de sujets témoins appariés selon

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Unplanned admission rates and postdischarge complications in patients over the age of 70 following day case surgery

Cited by 50 publications

References 3 publications

Unplanned admission after day surgery: A historical cohort study in patients with obstructive sleep apnea

Unplanned admission after day surgery: A historical cohort study in patients with obstructive sleep apnea

A prospective observational study of the safety and acceptability of vaginal hysterectomy performed in a 24‐hour day case surgery setting

Increased incidence of postoperative cognitive dysfunction 24 hr after minor surgery in the elderly

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