Green Zoe, Woodman Natasha, McLernon David J, Engelhardt Thomas
Sheffield Children's Hospital, Sheffield, UK.
King's College Hospital, London, UK.
Br J Anaesth. 2020 Apr;124(4):463-472. doi: 10.1016/j.bja.2019.11.035. Epub 2020 Feb 4.
Failure to discharge home after day-case procedures has a negative impact on patients, families, and hospital finances. There are currently no national paediatric data on the incidence and causes of unplanned admission. We determined the incidence of unplanned admissions after paediatric day-case anaesthesia, and identified risk factors leading to unplanned admission.
During a 6 week period (in October and November 2017), all children aged 16 yr or under receiving general anaesthesia without an inpatient bed on arrival were included. Hospital, surgical, and procedural details; anonymised patient characteristic data; and anaesthetic and surgical experience were collected by local Paediatric Anaesthesia Trainee Research Network coordinators. A mixed-effects binary logistic regression model with backward selection was used to determine variables associated with unplanned admission.
Ninety three hospitals across the UK and Ireland participated. There were 25 986 cases, of which 640 were unplanned admissions. The independent risk factors for unplanned admission were ASA-physical status (PS) (ASA-PS 3/4 vs ASA-PS 1; odds ratio [OR]: 2.80 [95% confidence interval {CI}: 2.07-3.77]), duration of procedure (OR: 1.04 [95% CI: 1.03-1.05]), and surgical specialty (vs ear, nose, and throat [highest caseload specialty]: cardiology OR: 1.89 [95% CI: 1.15-3.06], orthopaedics/trauma OR: 0.91 [95% CI: 0.69-1.18], and general surgery OR: 0.59 [95% CI: 0.46-0.77]). The commonest reasons for admission were unexpected surgical complexity, pain, postoperative nausea and vomiting, and late finish.
Paediatric patient physical status, some types of surgery and duration of procedure were associated with unplanned day-surgery admissions. Unexpected surgical complexity and patient discomfort in recovery were common factors.
日间手术术后未能出院对患者、家庭及医院财务均有负面影响。目前尚无关于非计划入院发生率及原因的全国性儿科数据。我们确定了小儿日间麻醉后非计划入院的发生率，并识别了导致非计划入院的风险因素。
在2017年10月和11月的6周期间，纳入所有16岁及以下、入院时未安排住院床位且接受全身麻醉的儿童。由当地儿科麻醉实习研究网络协调员收集医院、手术及操作细节；匿名化的患者特征数据；以及麻醉和手术经验。采用带有向后选择的混合效应二元逻辑回归模型来确定与非计划入院相关的变量。
英国和爱尔兰的93家医院参与了研究。共有25986例病例，其中640例为非计划入院。非计划入院的独立风险因素包括美国麻醉医师协会身体状况（ASA-PS）（ASA-PS 3/4对比ASA-PS 1；比值比[OR]：2.80[95%置信区间{CI}：2.07 - 3.77]）、手术时长（OR：1.04[95% CI：1.03 - 1.05]）以及手术专科（对比耳鼻喉科[病例数最多的专科]：心脏病学OR：1.89[95% CI：1.15 - 3.06]，骨科/创伤科OR：0.91[95% CI：0.69 - 1.18]，普通外科OR：0.59[95% CI：0.46 - 0.77]）。入院的最常见原因是意外的手术复杂性、疼痛、术后恶心和呕吐以及手术延迟结束。
儿科患者的身体状况、某些类型的手术以及手术时长与非计划日间手术入院有关。意外的手术复杂性和患者恢复过程中的不适是常见因素。
