Comparison of unscheduled hospital admission following ambulatory operative laparoscopy at a teaching hospital and a community hospital.

The objective was to identify and compare causes of unscheduled admission following ambulatory major operative gynecologic laparoscopy in a university hospital and a community hospital setting. Each patient admitted on an unscheduled basis was compared with 2 patients who did not require admission. Twenty-seven variables were evaluated by univariate analysis. Significant factors (p < 0.5) were analyzed by multivariate stepwise logistic regression. Patients admitted at the university hospital were compared with patients at a community hospital. In a 7-year period, 43 patients at the University of Mississippi Medical Center and, in a 6-year period, 30 patients at Gilmore Memorial Hospital required unscheduled admission following ambulatory major operative gynecologic laparoscopy. Site-specific analysis was performed, and these groups also were combined for analysis. The only factor associated with admission by multivariate analysis was estimated operative blood loss. Postoperative emesis was the most common reason for unscheduled admission at both hospitals and occurred in 27 patients. An additional 17 patients were admitted because of the severity of postoperative pain. Operative blood loss seems to be associated with extensive operations. Furthermore, increased blood loss typically leads to a very conservative approach to the postoperative patient, whereas minimal blood loss allows patients to be managed in a routine fashion. Patients at the university hospital seem to be generally comparable to patients at a community hospital. Postoperative nausea and pain resulted in over one half of admissions. Successful therapy for nausea and pain may reduce unscheduled admissions.