Shah Syed, Qureshi Faiza, Stanley Samuel, Bennett-Guerrero Elliott
Department of Anesthesiology, Stony Brook University Medical Center, Stony Brook, USA.
Patient Care Services, Stony Brook Eastern Long Island Hospital, Stony Brook, USA.
Perioper Med (Lond). 2024 Aug 13;13(1):88. doi: 10.1186/s13741-024-00447-y.
Unplanned admission after surgery at an ambulatory surgery center (ASC) is an established measure of the quality of care and can affect the patient's experience. Previous studies on this topic are generally dated, focused on a single specialty, or studied 30-day admissions after ambulatory surgery. Few studies have reported admission within 24 h after surgery at an ASC which is a different but important measure of the quality of anesthetic and surgical care. Understanding admissions within 24 h of surgery can identify opportunities for improvement immediately after surgery. Therefore, our study was designed to assess the incidence and risk factors for unplanned hospital admissions within 24 h after surgery performed at a hospital ASC.
After Institutional Review Board approval, a retrospective analysis was performed on all adult patients who underwent surgery at a US ASC between January 1, 2016, and December 31, 2022. Data were obtained from the hospital's electronic medical record. The study sample was divided into two groups: those with an unplanned hospital admission within 24 h after surgery and those without an unplanned hospital admission. To evaluate risk factors for unplanned hospital admissions, univariate analyses with p value < 0.05 were utilized to identify significant patient variables related to hospital admissions. These variables were further adjusted using a multivariable Firth logistic regression. Descriptive statistics were used to explore the number of patients in different variable categories.
Overall, 53,185 cases were identified for the 7-year period. The incidence of unplanned hospital admission over this period was 0.09% (95% CI 0.07-0.1122%; ranging from 0.05 to 0.12% per year. In the multivariable model, surgery duration (OR 1.010, 95% CI 1.007-1.012, p value < 0.0001), peripheral vascular disease (OR 14.489, 95% CI 4.862-43.174, p value < 0.0001), and deep venous thrombosis (OR 5.527, 95% CI 1.909-16.001, p value = 0.0016) were significantly associated with unplanned hospital admission.
The overall incidence of unplanned hospital admission after surgery at a large tertiary care ambulatory surgery center is very low. This admission rate can also serve as a reference point for future studies and quality improvement initiatives.
门诊手术中心（ASC）术后非计划入院是衡量医疗质量的既定指标，会影响患者体验。此前关于该主题的研究通常较为陈旧，聚焦于单一专科，或研究门诊手术后30天内的入院情况。很少有研究报告ASC术后24小时内的入院情况，这是衡量麻醉和手术护理质量的一个不同但重要的指标。了解术后24小时内的入院情况可以在术后立即发现改进机会。因此，我们的研究旨在评估在医院ASC进行手术后24小时内非计划住院的发生率和风险因素。
经机构审查委员会批准后，对2016年1月1日至2022年12月31日期间在美国ASC接受手术的所有成年患者进行回顾性分析。数据从医院电子病历中获取。研究样本分为两组：术后24小时内非计划住院的患者和无非计划住院的患者。为评估非计划住院的风险因素，采用p值<0.05的单因素分析来确定与住院相关的显著患者变量。这些变量通过多变量Firth逻辑回归进一步调整。描述性统计用于探索不同变量类别中的患者数量。
总体而言，7年期间共识别出53185例病例。在此期间，非计划住院的发生率为0.09%（95%CI 0.07 - 0.1122%；每年范围为0.05%至0.12%）。在多变量模型中，手术时长（OR 1.010，95%CI 1.007 - 1.012，p值<0.0001）、外周血管疾病（OR 14.489，95%CI 4.862 - 43.174，p值<0.0001）和深静脉血栓形成（OR 5.527，95%CI 1.909 - 16.001，p值 = 0.0016）与非计划住院显著相关。
大型三级医疗门诊手术中心术后非计划住院的总体发生率非常低。该入院率也可为未来研究和质量改进举措提供参考。
