Fortier J, Chung F, Su J. Unanticipated admission after ambulatory surgery: a prospective study. Can J Anaesth 45: 612-9

Department of Anaesthesia, CHUM-Hotel-Dieu Campus, Toronto, Ontario, Canada.
Canadian Journal of Anaesthesia (Impact Factor: 2.53). 08/1998; 45(7):612-9. DOI: 10.1007/BF03012088
Source: PubMed


To determine the incidence, the reasons, and the predictive factors for unanticipated admission after ambulatory surgery.
Preoperative, intraoperative, and postoperative data were collected prospectively on 15,172 consecutive ambulatory surgical patients during a 32-month period. The data were built into a statistical model, and predictive factors were identified and classified.
The overall incidence of unanticipated admission was 1.42%. Admitted patients were more likely to be older, male, and ASA status II or III. Duration of anaesthesia was longer, and surgery was more likely to be completed after 3 pm. Length of stay in the Postanaesthesia Care Unit and the Ambulatory Surgery Unit was longer. Surgical reasons were cited in 38.1% of admitted patients; anaesthesia-related reasons were cited in 25%; social reasons accounted for 19.5%, and medical reasons for 17.2%. Ear, nose and throat (ENT) patients had the highest unanticipated admission rate (18.2%), followed by urology (4.8%) and chronic pain block (3.9%). Gynaecological patients had the lowest rate (0.4%). Among the predictive factors found were male, ASA status II and III, long duration of surgery, surgery finishing after 3 pm, postoperative bleeding, excessive pain, nausea and vomiting, and excessive drowsiness or dizziness.
Earlier operating time for certain surgical procedures, screening for proper support at home, and implementation of clinical pathways to deal aggressively with problems such as pain, nausea and vomiting should decrease the incidence of unanticipated admission.

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    • "The perioperative care for a patient's quality of life is an important concern in an ambulatory surgery.5) However, many patients undergoing ambulatory surgery under general anesthesia experience unacceptable levels of nausea and vomiting (N/V) after surgery.6,7) "
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    ABSTRACT: BACKGROUND: Patients undergoing ambulatory surgery under general anesthesia experience considerable levels of postoperative nausea and vomiting (N/V) after their discharge. However, those complications have not been thoroughly investigated in hand surgery patients yet. We investigated factors associated with postoperative N/V in patients undergoing an ambulatory hand surgery under general anesthesia and determined whether patients' satisfaction with this setting is associated with postoperative N/V levels.
    Clinics in orthopedic surgery 09/2014; 6(3):273-8. DOI:10.4055/cios.2014.6.3.273
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    • "Cohort studies and clinical experience indicate that the practice is safe. Major morbidity is rare [3], discharge home is successful on the day of the operation [4,5], readmission to the hospital is seldom required, and overall patient satisfaction is high [6,7]. "
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    ABSTRACT: Background Increasing numbers of elective surgical procedures are performed as day-cases. The impact of ambulatory surgery on health-related quality of life in the recovery period has seldom been described. Methods We assessed health-related quality of life in 143 adult outpatients scheduled for arthroscopic procedures of the knee and shoulder joints, laparoscopic cholecystectomy and inguinal hernia repair using the RAND 36-Item Health Survey preoperatively and one week after patients had returned to work or comparable normal daily routines. Results Postoperatively all patient groups reported significant improvements in bodily pain and vitality. Physical functioning improved significantly in orthopedic and inguinal hernia patients. However, in the orthopedic groups, postoperative scores for physical health were still relatively lower compared to the general population reference values. Conclusions Ambulatory surgery has a positive impact on health-related quality of life. Assessment of the recovery process is necessary for recognition of potential areas of improvement in care and postoperative rehabilitation.
    BMC Anesthesiology 12/2012; 12(1):30. DOI:10.1186/1471-2253-12-30 · 1.38 Impact Factor
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    • "Despite these findings, PONV is still a common complication of anesthesia and the number one cause of unanticipated admission after surgery [1,10]. Emesis pathophysiology is multifactorial, incited by drugs, environment, radiation and disease states [11,12]. "
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    ABSTRACT: The incidence of postoperative nausea and vomiting (PONV) is 50% to 80% after neurosurgery. The common prophylactic treatment for postoperative nausea and vomiting is a triple therapy of droperidol, promethazine and dexamethasone. Newer, more effectives methods of prophylaxis are being investigated. We designed this prospective, double-blind, single-center study to compare the efficacy of ondansetron, a neurokinin-1 antagonist, and aprepitant, as a substitute for droperidol, in the prophylactic treatment of postoperative nausea and vomiting after neurosurgery. After obtaining institutional review board approval; 176 patients, 18 to 85 years of age with American Society of Anesthesiologists (ASA) classifications I to III, who did not receive antiemetics 24 h before surgery and were expected to undergo general anesthesia for neurosurgery lasting longer than 2 h were included in this study. After meeting the inclusion and exclusion criteria and providing written informed consent, patients were randomly assigned in a 1:1 ratio to one of two treatment groups: aprepitant or ondansetron. The objective of this study was to conduct a randomized, double-blind, double-dummy, parallel-group and single-center trial to compare and evaluate the efficacies of aprepitant versus ondansetron. Patients received oral aprepitant 40 mg OR oral dummy pill within 2 h prior to induction. At induction, a combination of intravenous dexamethasone 10 mg, promethazine 25 mg, and ondansetron 4 mg OR dummy injection was administered. Therefore, all patients received one dummy treatment and three active PONV prophylactic medications: dexamethasone 10 mg, promethazine 25 mg, and either aprepitant 40 mg OR ondansetron 4 mg infusion. The primary outcome measures were the episodes and severity of nausea and vomiting; administration of rescue antiemetic; and opioid consumption for 120 h postoperatively. Standard safety assessments included adverse event reports, physical and laboratory data, awakening time and duration of recovery from anesthesia. The results of this comparative study could potentially identify an improved treatment regimen that may decrease the incidence and severity of postoperative nausea and vomiting in patients undergoing neurosurgery. Also, this will serve to enhance patient recovery and overall satisfaction of neurosurgical patients in the immediate postoperative period. Registered at The Ohio State University Biomedical Sciences Institutional Review Board: Protocol Number: 2007 H0053.
    Trials 08/2012; 13:130. DOI:10.1186/1745-6215-13-130 · 1.73 Impact Factor
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