Sawhney Monakshi, Goldstein David H, Wei Xuejiao, Pare Genevieve C, Wang Louie, VanDenKerkhof Elizabeth G
School of Nursing, Queen's University, 92 Barrie Street, Kingston, Ontario K7L 3N6 Canada.
Department of Anesthesiology and Perioperative Medicine, Queen's University, Victory 2, Kingston General Hospital, 76 Stuart Street, Kingston, Ontario K7L 2V7 Canada.
Perioper Med (Lond). 2020 Aug 19;9:25. doi: 10.1186/s13741-020-00155-3. eCollection 2020.
Advances in healthcare delivery have allowed for the increase in the number of ambulatory surgery procedures performed in Canada. Despite these advances, patients return to hospital following discharge. However, the reason for unplanned healthcare use after ambulatory surgery in Canada is not well understood.
To examine unplanned healthcare use, specifically emergency department visit and hospital admissions, in the 3 days after ambulatory surgery in Ontario, Canada.
This population-based retrospective cohort study was conducted using de-identified administrative databases. Participants were residents in the province of Ontario, Canada; 18 years and older; and underwent common ambulatory surgical procedures between 2014 and 2018. The outcomes included emergency department (ED) visit and hospital admission. Incidence rates were calculated for the total cohort, for each patient characteristic and for surgical category. The odds ratios and 95% confidence intervals were calculated for each outcome using bivariate and multivariate logistic regression.
484,670 adults underwent select common surgical procedures during the study period. Patients had healthcare use in the first 3 days after surgery, with 14,950 (3.1%) ED visits and 14,236 (2.9%) admissions. The incidence of ED use was highest after tonsillectomy (8.1%), cholecystectomy (4.2%) and appendectomy (4.0%). Incidence of admissions was highest after appendectomy (21%). Acute pain (19.7%) and haemorrhage (14.2%) were the most frequent reasons for an ED visit and "convalescence following surgery" (49.2%) followed by acute pain (6.2%) and haemorrhage (4.5%) were the main reasons for admission.
These findings can assist clinicians in identifying and intervening with patients at risk of healthcare use after ambulatory surgery. Pain management strategies that can be tailored to the patient, and earlier follow-up for some patients may be required. In addition, administrative decision-makers could use the results to estimate the impact of specific ambulatory procedures on hospital resources for planning and allocation of resources.
医疗服务的进步使得加拿大门诊手术的数量有所增加。尽管有这些进步，但患者出院后仍会返回医院。然而，加拿大门诊手术后非计划医疗使用的原因尚不清楚。
研究加拿大安大略省门诊手术后3天内的非计划医疗使用情况，特别是急诊就诊和住院情况。
本基于人群的回顾性队列研究使用了去识别化的行政数据库。参与者为加拿大安大略省居民；年龄在18岁及以上；在2014年至2018年期间接受了常见的门诊手术。结局包括急诊就诊和住院。计算了整个队列、每个患者特征以及手术类别的发病率。使用二元和多元逻辑回归计算每个结局的比值比和95%置信区间。
在研究期间，484,670名成年人接受了选定的常见手术。患者在术后前3天有医疗使用情况，其中14,950人（3.1%）急诊就诊，14,236人（2.9%）住院。扁桃体切除术后急诊使用的发生率最高（8.1%），胆囊切除术后（4.2%）和阑尾切除术后（4.0%）。阑尾切除术后住院发生率最高（21%）。急性疼痛（19.7%）和出血（14.2%）是急诊就诊最常见的原因，“术后康复”（49.2%）其次是急性疼痛（6.2%）和出血（4.5%）是住院的主要原因。
这些发现可帮助临床医生识别门诊手术后有医疗使用风险的患者并进行干预。可能需要针对患者量身定制疼痛管理策略，并对一些患者进行更早的随访。此外，行政决策者可利用这些结果来估计特定门诊手术对医院资源的影响，以便进行资源规划和分配。
