Factors affecting unanticipated hospital admission following otolaryngologic day surgery.
BACKGROUND
Day surgery constitutes an important part of modern otolaryngology practice. However, high rates of unplanned admissions remain an issue.


OBJECTIVE
To determine the incidence, reasons, and predictive factors for unanticipated admission after ambulatory otolaryngologic surgery.


METHODS
A retrospective review of all cases of unplanned admission following otolaryngology day surgery at a tertiary care centre over a 4-year period from 2000 to 2004. Data relating to patient demographics, physical status, surgical procedure, perioperative complications, and reasons for hospital admission were recorded. A case-control analysis of these parameters with nonadmitted day surgery patients was used for comparison.


RESULTS
During the above period, 1106 patients underwent otolaryngologic day surgery, of whom 74 (6.7%) required admission. Fifty-seven percent of the patients were male, and the average age was 48.9 years. The three most common procedures with unplanned admission were open neck biopsy (27%), functional endoscopic sinus surgery (20.3%), and panendoscopy (16.2%). The reasons for admission could be divided into airway monitoring (37.7%), postoperative bleeding (28.6%), the need for supportive or pain management (19.5%), anesthetic complication (5.2%), cardiovascular complication (3.9%), clerical error (3.9%), and suspicion of a cerebrospinal fluid leak (1.3%). Risk factors for admission were determined to be an American Society of Anesthesiologists' class of 3 or greater, open neck surgical procedures, and a length of surgery of 60 minutes or greater. Minor factors included the use of general anesthesia, male gender, advanced age, and living far from a hospital.


CONCLUSIONS
This study suggests strategies to reduce the rate of unplanned admission by means of careful preoperative assessment and planning, patient selection, careful scheduling of higher-risk patients, and appropriate postoperative observation and management.
Tewfik
Marc A
MA
Department of Otolaryngology-Head and Neck Surgery, Royal Victoria Hospital, McGill University, Montreal, Quebec. marc.tewfik@mail.mcgill.ca
Frenkiel
Saul
S
Gasparrini
Rosa
R
Zeitouni
Anthony
A
Daniel
Sam J
SJ
Dolev
Yalon
Y
Kost
Karen
K
Samaha
Mark
M
Sweet
Robert
R
Tewfik
Ted L
TL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects*; D000704:Analysis of Variance; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000009:adverse effects*; D010343:Patient Admission / Q000706:statistics & numerical data*; D010347:Patient Care Planning; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors