Sueda Aya, Kagawa Tetsuro, Kojima Taiki
Department of Anesthesiology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo, Japan.
Department of Anesthesiology, Aichi Children's Health and Medical Center, 7-426 Morioka, Obu, Aichi, 474-8710, Japan.
J Anesth. 2025 Apr;39(2):215-222. doi: 10.1007/s00540-024-03445-y. Epub 2024 Dec 21.
Unplanned hospital admission following pediatric day surgery is a crucial quality indicator. This study examined the incidence, related risks, interventions, and outcomes of unplanned hospital admission following pediatric day surgery among children in Japan.
This single-center, retrospective study analyzed data of 14,529 pediatric patients under the age of 18 years who underwent day surgery between August 2007 and December 2022. Unplanned hospital admission was defined as an overnight hospital stay that was not planned preoperatively, including patients who returned to the emergency department and required admission within 24 h of discharge. Reasons for unplanned hospital admission and interventions were categorized, and risk factors were identified using logistic regression.
The incidence of unplanned hospital admission was 0.19%. The most common reasons for unplanned hospital admission were anesthetic-related, particularly postoperative nausea and vomiting (36%), which was managed primarily with intravenous fluids (36%) and antiemetic medications (21%). Medical and surgical factors were next most common. Logistic regression identified longer operation time (adjusted Odds ratio 1.03; 95% confidence interval [1.01, 1.04]; P < 0.001) and exit from the operating room after 15:00 (adjusted Odds ratio 29.3; 95% confidence interval [7.09, 121]; P < 0.001) as significant risk factors for unplanned hospital admission.
Unplanned hospital admission was most commonly anesthetic-related and was managed with intravenous fluids and antiemetic medications. Longer operation time and later exit from the operating room were significant risk factors. These findings can guide targeted strategies to further reduce unplanned hospital admission and improve pediatric day surgery quality.
小儿日间手术后的非计划性住院是一项关键的质量指标。本研究调查了日本儿童小儿日间手术后非计划性住院的发生率、相关风险、干预措施及结局。
这项单中心回顾性研究分析了2007年8月至2022年12月期间接受日间手术的14529例18岁以下小儿患者的数据。非计划性住院定义为术前未计划的过夜住院，包括返回急诊科并在出院后24小时内需要住院的患者。对非计划性住院的原因和干预措施进行分类，并使用逻辑回归确定风险因素。
非计划性住院的发生率为0.19%。非计划性住院最常见的原因与麻醉相关，尤其是术后恶心和呕吐（36%），主要通过静脉输液（36%）和抗呕吐药物（21%）进行处理。其次是医疗和手术因素。逻辑回归确定较长的手术时间（调整优势比1.03；95%置信区间[1.01, 1.04]；P < 0.001）和15:00后离开手术室（调整优势比29.3；95%置信区间[7.09, 121]；P < 0.001）是非计划性住院的显著风险因素。
非计划性住院最常见的原因与麻醉相关，通过静脉输液和抗呕吐药物进行处理。较长的手术时间和较晚离开手术室是显著的风险因素。这些发现可指导有针对性的策略，以进一步减少非计划性住院并提高小儿日间手术质量。
