title: Outpatient endoscopic sinus surgery in cystic fibrosis patients: predictive factors for admission.
abstract: BACKGROUND
  An increasing number of adult patients with cystic fibrosis (CF) are becoming candidates for elective endoscopic sinus surgery (ESS). We sought to identify perioperative factors in this patient population that were predictive of postoperative admission.
  
  
  METHODS
  Retrospective chart review of CF patients who underwent ESS during the years 2005 through 2012. Multiple preoperative, intraoperative, and immediate postoperative variables were analyzed.
  
  
  RESULTS
  Thirty-three patients who underwent 37 outpatient ESSs were identified. Successful same-day discharge was observed in 54%. In 46% of cases, postoperative admission was necessary, with a mean postoperative stay of 1.4 days. Pulmonary function, CF-related comorbidities, and history of lung transplant were not predictors of postoperative admission. Univariate analysis demonstrated that patients were more likely to be admitted if they had 1 of the following conditions: history of ≥4 prior ESS; procedure duration >2.5 hours; intraoperative blood loss greater than 150 mL; increased immediate postoperative pain scores; or larger narcotic requirements for pain control. On logistic regression analysis, a maximum pain score ≥ 7 out of 10 in the postanesthesia recovery unit was the only significant predisposing factor for postoperative admission.
  
  
  CONCLUSIONS
  Although over 50% of adult CF patients can successfully undergo ESS on a same-day discharge basis, it is prudent to have contingent plans for potential inpatient observation postoperatively. Multivariate analysis suggests that preoperative demographics and pulmonary status cannot predict the need for postoperative admission, whereas higher pain scores in the postanesthesia care unit are predictive of the necessity for inpatient observation.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA.
authors.forename: Ethan
authors.initials: E
authors.lastname: Soudry
authors.forename: Paul K
authors.initials: PK
authors.lastname: Mohabir
authors.forename: Amar
authors.initials: A
authors.lastname: Miglani
authors.forename: Justin
authors.initials: J
authors.lastname: Chen
authors.forename: Jayakar V
authors.initials: JV
authors.lastname: Nayak
authors.forename: Peter H
authors.initials: PH
authors.lastname: Hwang
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care; D000700:Analgesics / Q000627:therapeutic use; D000777:Anesthetics / Q000627:therapeutic use; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D003550:Cystic Fibrosis / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D010256:Paranasal Sinuses / Q000601:surgery*; D010343:Patient Admission / Q000706:statistics & numerical data*; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000700:Analgesics; D000777:Anesthetics
keywords: cystic fibrosis; endoscopic sinus surgery; outpatient; pain; postoperative admission; predicting factors