Department of Anesthesia, McMaster University, Hamilton, ON, Canada.
Can J Anaesth. 2013 Jul;60(7):675-83. doi: 10.1007/s12630-013-9935-5. Epub 2013 Apr 19.
The primary objectives of this historical case-control 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.
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.
The 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] 16.70; 95% confidence interval [CI] 4.10 to 67.99) and length of surgery more than three hours (OR 4.26; 95% CI 2.40 to 7.55); ASA class III (OR 4.60; 95% CI 1.81 to 11.68); ASA class IV (OR 6.51; 95% CI 1.66 to 25.59); advanced age (> 80 yr) (OR 5.41; 95% CI 1.54 to 19.01); and body mass index (BMI) of 30-35 (OR 2.81; 95% CI 1.31 to 6.04). Current smoking status was found to be associated with a decreased likelihood of unanticipated admission (OR 0.44; 95% CI 0.23 to 0.83), as was monitored anesthesia care when compared with general anesthesia (OR 0.17; 95% CI 0.04 to 0.68) and plastic (OR 0.18; 95% CI 0.07 to 0.50), orthopedic (OR 0.16; 95% CI 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.
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.
本回顾性病例对照研究的主要目的是评估加拿大三家三级护理医院在门诊手术后，成人非预期住院的发生率、原因和危险因素。
从 20657 例门诊手术中随机抽取 200 例需住院治疗的患者（病例）和 200 例无需住院治疗的患者（对照组）进行比较。纳入以下变量：人口统计学、入院原因、麻醉类型、手术类型、手术时间、美国麻醉师协会（ASA）分级、手术完成时间、术前诊所、病史、药物（类别）和围手术期并发症。采用多因素逻辑回归分析评估与非预期住院相关的因素。
门诊手术后非预期住院的发生率为 2.67%。最常见的入院原因是手术（40%）、麻醉（20%）和医疗（19%）。以下因素与非预期住院风险增加相关：手术时间 1-3 小时（比值比[OR] 16.70；95%置信区间[CI] 4.10 至 67.99）和手术时间超过 3 小时（OR 4.26；95% CI 2.40 至 7.55）；ASA 分级 III（OR 4.60；95% CI 1.81 至 11.68）；ASA 分级 IV（OR 6.51；95% CI 1.66 至 25.59）；高龄（>80 岁）（OR 5.41；95% CI 1.54 至 19.01）和 BMI 为 30-35（OR 2.81；95% CI 1.31 至 6.04）。与非预期住院相关的因素还包括：当前吸烟状态（OR 0.44；95% CI 0.23 至 0.83）、与全身麻醉相比，监测麻醉护理（OR 0.17；95% CI 0.04 至 0.68）和整形（OR 0.18；95% CI 0.07 至 0.50）、骨科（OR 0.16；95% CI 0.08 至 0.33）和牙科/耳鼻喉手术（OR 0.32；95% CI 0.13 至 0.83）。其他合并症并不影响非预期住院。
门诊手术后非预期住院主要由手术、麻醉和医疗并发症引起。手术时间超过 1 小时、ASA 分级较高、年龄较大和 BMI 增加均为预测因素。无特定合并症与非预期住院的可能性增加相关。这些发现支持继续使用 ASA 分级作为患者围手术期风险的标志物，而不是将风险归因于特定疾病过程。
