Factors influencing unexpected disposition after orthopedic ambulatory surgery.
OBJECTIVE
To analyze whether patient characteristics, ambulatory facility type, anesthesia provider and technique, procedure type, and temporal factors impact the outcome of unexpected disposition after ambulatory knee and shoulder surgery.


METHODS
Retrospective analysis of a national database.


METHODS
Freestanding and hospital-based ambulatory surgery facilities.


METHODS
Ambulatory knee and shoulder surgery cases from 1996 and 2006 were identified through the National Survey of Ambulatory Surgery. The incidence of unexpected disposition status was determined and risk factors for such outcome were analyzed.


RESULTS
Factors independently increasing the risk for unexpected disposition included procedures performed in hospital-based versus freestanding facilities [odds ratio (OR) 6.83 (95% confidence interval [CI] 4.34; 10.75)], shoulder versus knee procedures [OR 3.84 (CI 2.55; 5.77)], anesthesia provided by nonanesthesiology professionals and certified registered nurse-anesthetists versus anesthesiologists [OR 7.33 (CI 4.18; 12.84) and OR 1.80 (CI 1.09; 2.99), respectively]. Decreased risk for unexpected disposition was for procedures performed in 2006 versus 1996 [OR 0.15 (CI 0.10; 0.24)] and the use of anesthesia other than regional or general [OR 0.34 (CI 0.18; 0.68)].


CONCLUSIONS
The decreased risk for unexpected disposition associated with more recent data and with freestanding versus hospital-based facilities may represent improvements in efficiency, while the decreased odds for such disposition status associated with the use of other than general or regional anesthesia may be related to a lower invasiveness of cases. We found an increased risk of adverse disposition in cases where the anesthesia provider was a nonanesthesiology professional. No difference in this outcome was noted when an anesthesia care team provided care.
Department of Anesthesiology, Hospital for Special Surgery, New York, NY 10021, USA. MemtsoudisS@hss.edu
Stavros G
SG
Memtsoudis
Yan
Y
Ma
Cephas P
CP
Swamidoss
Alison M
AM
Edwards
Madhu
M
Mazumdar
Gregory A
GA
Liguori
D000293:Adolescent; D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D000556:Ambulatory Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data*; D000758:Anesthesia / Q000379:methods; D000776:Anesthesiology / Q000379:methods / Q000706:statistics & numerical data; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D012785:Shoulder Joint / Q000601:surgery; D014481:United States; D055815:Young Adult