title: Unplanned admissions following ambulatory plastic surgery--a retrospective study.
abstract: BACKGROUND
  Admission for overnight or longer hospital stay from a day-case unit is an unwelcome event. This audit was designed to identify the incidence of unplanned admissions and also to detect the potential factors for such overstays.
  
  
  METHODS
  Details of plastic surgical day-case patients were obtained from the hospital records for a period of 6 months (February 2002 to July 2002).
  
  
  RESULTS
  The total number of unplanned admissions was 28 (3.55%). High rates were recorded in patients above the age of 80 years, male patients and body mass index > 30 kg/m2. Duration of surgery (> 45 min) and waiting time in the day surgery unit (> 2.5 h) had significant correlation with the overstays. Grade of the surgeon was not an important determinant factor. Of procedures which resulted in an unexpected admission, the most frequent were otoplasty (8.4%; n = 71) and fasciectomy for Dupuytren's contracture (14.5%; n = 41). Unexpected admissions were also high following rhinoplasty and nipple reconstruction but the total number of operations performed were not significant (n = 12 in each group). Overall, the cause of the overstays were mostly surgical (71.4%) followed by anaesthetic (28.5%) and social (7.1%).
  
  
  CONCLUSIONS
  With an overall unplanned admission rate of 3.55%, our unit is close to the national standard of 2-3%, as advocated by The Royal College of Surgeons of England. Postoperative bleeding (60%) was the most important surgical reason for overstays followed by intravenous antibiotics, wound drainage, excessive duration of the procedure and additional, unplanned procedures. Among the anaesthetic factors, postoperative pain was the leading cause (62.5%) followed by nausea, vomiting and adverse anaesthetic reaction.
  
  
  CONCLUSIONS
  The reasons for unplanned admissions are multifactorial and merit appropriate patient selection and proper estimation of the disease process.
authors.affiliation: Department of Plastic & Reconstructive Surgery, University Hospital of North Durham, UK.
authors.forename: A
authors.initials: A
authors.lastname: Mandal
authors.forename: D
authors.initials: D
authors.lastname: Imran
authors.forename: T
authors.initials: T
authors.lastname: McKinnell
authors.forename: G S
authors.initials: GS
authors.lastname: Rao
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology*; D019106:Postoperative Hemorrhage / Q000209:etiology*; D012189:Retrospective Studies; D013518:Surgery, Plastic / Q000009:adverse effects* / Q000706:statistics & numerical data