Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.
Division of Otolaryngology/Head and Neck Surgery, Department of Surgery, Albany Medical Center, Albany, New York, U.S.A.
Laryngoscope. 2022 Mar;132(3):518-522. doi: 10.1002/lary.29687. Epub 2021 Jun 14.
OBJECTIVES/HYPOTHESIS: To identify factors that may increase the risk of unplanned admission following elective outpatient endoscopic sinonasal surgery (ESS).
Retrospective analysis of the National Surgical Quality Improvement Program (NSQIP).
All cases of ESS were extracted from the 2010 to 2018 NSQIP database using Current Procedural Terminology codes. Only cases coded as outpatient, elective, and nonemergent procedures were included. Unplanned admissions were defined as cases with a total hospital stay of 1 day or more. Univariate and multivariate analyses were performed to identify variables that independently predicted unanticipated admission.
A total of 971 cases met inclusion criteria, of which 274 (28.2%) were unanticipated admissions. Patients in the unplanned admission group were more likely to be older (46.8 vs. 41.1 years, P < .001), male (57.7% vs. 48.4%, P = .009), obese (54.8% vs. 43.8%, P = .003), and have hypertension (35.0% vs. 25.0%, P = .002). Unplanned admitted patients were also more likely to be included under American Society of Anesthesiologists (ASA) classification III-IV (43.1% vs. 27.2%, P < .001). There were no significant differences in race, smoking, diabetes, or chronic steroid use. Unplanned admitted patients had a higher rate of surgical complications (2.9% vs. 1.0%, P = .041). Upon multivariate analysis, independent preoperative risk factors for unplanned admission included age (OR: 1.018, P = .002), male gender (OR: 1.415, P = .025), obesity (OR: 1.527, P = .008), and ASA III-IV (OR 1.501, P = .018).
Factors independently associated with unplanned admission following outpatient ESS were older age, male gender, obesity, and higher ASA. Identification of patients at risk may reduce unanticipated hospital admission after ESS.
4 Laryngoscope, 132:518-522, 2022.
目的/假设：确定可能增加择期门诊内镜鼻窦手术（ESS）后非计划入院风险的因素。
国家手术质量改进计划（NSQIP）的回顾性分析。
使用当前程序术语代码从 2010 年至 2018 年 NSQIP 数据库中提取所有 ESS 病例。仅包括编码为门诊、择期和非紧急手术的病例。非计划入院定义为总住院时间为 1 天或以上的病例。进行单变量和多变量分析，以确定独立预测意外入院的变量。
共有 971 例符合纳入标准，其中 274 例（28.2%）为非计划入院。非计划入院组患者年龄更大（46.8 岁比 41.1 岁，P<0.001），男性（57.7%比 48.4%，P=0.009），肥胖（54.8%比 43.8%，P=0.003），高血压（35.0%比 25.0%，P=0.002）。非计划入院患者也更有可能被归类为美国麻醉医师协会（ASA）分类 III-IV 级（43.1%比 27.2%，P<0.001）。种族、吸烟、糖尿病或慢性类固醇使用无显著差异。非计划入院患者的手术并发症发生率更高（2.9%比 1.0%，P=0.041）。多变量分析后，非计划入院的独立术前危险因素包括年龄（OR：1.018，P=0.002）、男性（OR：1.415，P=0.025）、肥胖（OR：1.527，P=0.008）和 ASA III-IV 级（OR 1.501，P=0.018）。
与门诊 ESS 后非计划入院相关的独立因素包括年龄较大、男性、肥胖和较高的 ASA。识别有风险的患者可能会降低 ESS 后非预期住院的风险。
4 级喉镜，132:518-522，2022 年。
