Ambulatory Surgery Center, Ghent University Hospital, Ghent, Belgium.
Faculty of Medicine and Health Sciences, Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium.
Acta Chir Belg. 2022 Jun;122(3):178-184. doi: 10.1080/00015458.2021.1893579. Epub 2021 Mar 8.
The incidence of adverse events in day surgery is an important quality indicator. This retrospective study investigated factors independently associated with unanticipated admission of pediatric patients after ambulatory surgery.
Ambulatory pediatric patients requiring unanticipated admission between January 2016 and December 2018 were compared to ambulatory pediatric patients who were discharged home after a planned surgery. Demographic data, organizational data, American Society of Anesthesiologists (ASA) classification, type of surgery, type of anesthesia, length of surgery, time of completion of the surgery, campus site, and season were collected in both groups. The reason for unexpected admission was classified according to four subtypes: anesthetic, medical, social/organizational and surgical reason, respectively. Multivariate logistic regression was used to identify independent factors associated with unanticipated admission.
From a total of 4235 pediatric patients, 78 children (1.9%) required unanticipated admission. The reasons for admission were anesthetic = 29 (37.3%), surgical = 20 (25.6%), medical = 16 (20.5%) and social/organizational = 13 (16.6%). Age <2 years (odds ratio [OR] 3.005, 95% confidence interval (CI) 1.500-6.018; ASA class 2 (OR 2.144; 95% CI 1.193-3.852); ASA class 3 (OR 11.617; CI 5.698-23.685); length of surgery >2 h (OR 3.056; CI 1.829-5.107); completion of surgery > 2:30 PM (OR 3.507; CI 1.854-6.633) and campus site (OR 3.628; CI 1.991-6.610) were factors significantly associated with unanticipated admission.
Children are less likely to be admitted after ambulatory surgery when preoperatively carefully selected and when prioritized considering age, general health condition and invasiveness of the surgery.
日间手术不良事件的发生率是一个重要的质量指标。本回顾性研究调查了与小儿门诊手术后意外住院相关的独立因素。
2016 年 1 月至 2018 年 12 月期间，需要意外住院的门诊小儿患者与计划手术后出院的门诊小儿患者进行比较。收集两组患者的人口统计学数据、组织数据、美国麻醉医师协会（ASA）分级、手术类型、麻醉类型、手术时间、手术完成时间、校园地点和季节。根据麻醉、医疗、社会/组织和手术原因，将意外住院的原因分为四个亚类。采用多变量逻辑回归分析确定与意外住院相关的独立因素。
从 4235 名儿科患者中，有 78 名（1.9%）需要意外住院。住院的原因是麻醉 29 例（37.3%）、手术 20 例（25.6%）、医疗 16 例（20.5%）和社会/组织 13 例（16.6%）。年龄<2 岁（比值比[OR]3.005，95%置信区间[CI]1.500-6.018；ASA 分级 2 级（OR 2.144；95% CI 1.193-3.852）；ASA 分级 3 级（OR 11.617；CI 5.698-23.685）；手术时间>2 小时（OR 3.056；CI 1.829-5.107）；手术完成时间>2：30 PM（OR 3.507；CI 1.854-6.633）和校园地点（OR 3.628；CI 1.991-6.610）是与意外住院相关的显著因素。
当术前仔细选择并根据年龄、一般健康状况和手术的侵袭性对手术进行优先排序时，小儿门诊手术后住院的可能性较小。
