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Unplanned hospital admission in children undergoing day-case surgery

Published online by Cambridge University Press:  23 December 2004

I. T. Awad ,
M. Moore ,
C. Rushe ,
A. Elburki ,
K. O'Brien  and
D. Warde
I. T. Awad
Affiliation:
The Children's University Hospital, Department of Anaesthesia and Intensive Care Medicine, Dublin, Republic of Ireland
M. Moore
Affiliation:
The Children's University Hospital, Department of Anaesthesia and Intensive Care Medicine, Dublin, Republic of Ireland
C. Rushe
Affiliation:
The Children's University Hospital, Department of Anaesthesia and Intensive Care Medicine, Dublin, Republic of Ireland
A. Elburki
Affiliation:
The Children's University Hospital, Department of Anaesthesia and Intensive Care Medicine, Dublin, Republic of Ireland
K. O'Brien
Affiliation:
The Children's University Hospital, Department of Anaesthesia and Intensive Care Medicine, Dublin, Republic of Ireland
D. Warde
Affiliation:
The Children's University Hospital, Department of Anaesthesia and Intensive Care Medicine, Dublin, Republic of Ireland
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Abstract

Summary

Background and objective: Unplanned hospital admission is a measure of quality of care in the setting of day-case surgery. We set out to identify the incidence and causes of unplanned hospital admission in a paediatric day-case unit.

Methods: A retrospective survey to determine the incidence and causes of unplanned hospital admissions in children undergoing day-case surgery. The survey covered the period from January 1996 until December 1999 inclusive in a university affiliated children’s hospital. This hospital is the second largest paediatric referral centre in Ireland with total admissions across all specialities during the study period of 42 738.

Results: During the study period 10 772 children underwent day-case surgery, of whom 242 (2.2%) experienced unplanned hospital admission. The reasons for admission were surgical 146 (54%), anaesthetic 44 (16%), social 38 (14%), medical 31 (11%) and unclassified 10 (4%). Pain, surgical complications and/or further management, admission for observation, extensive surgery and oozing were the commonest surgical reasons. Postoperative nausea and vomiting, anaesthetic-related complication and somnolence were the commonest anaesthetic causes responsible for admission. Surgery performed after 15:00 h was an important factor associated with admission for social reasons. Orthopaedic surgery accounted for the largest absolute number of unplanned admissions with 61 (25%), followed by urology with 46 (19%) and general surgery with 46 (19%). However, measured as percentage of caseload, urology had the highest proportion of unplanned hospital admissions.

Conclusion: This study demonstrated that the incidence and causes of unplanned hospital admission following day-case surgery in children are similar to those for adults.

Keywords

AMBULATORY SURGICAL PROCEDURESPAEDIATRICSPATIENT CARE, hospitalization, patient readmission
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 5 , May 2004 , pp. 379 - 383
Copyright
2004 European Society of Anaesthesiology

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References

Scaife JM, Campbell I. A comparison of the outcome of day-care and inpatient treatment of paediatric surgical cases. J Child Psychol Psychiat 1988; 29: 185–198.Google Scholar
Gold BS, Kitz DS, Lecky JH, Neuhaus JM. Unanticipated admission to the hospital following ambulatory surgery. JAMA 1989; 262: 3008–3010.Google Scholar
Fortier J, Chung F, Su J. Unanticipated admission after ambulatory surgery – a prospective study. Can J Anesth 1998; 45: 612–619.Google Scholar
Fancourt-Smith PE, Hornstein J, Jenkins LC. Hospital admission from the surgical day care centre of Vancouver General Hospital 1977–1987. Can J Anesth 1990; 37: 699–704.Google Scholar
Osborne GA, Rudkin GE. Outcome after day-case surgery in a major teaching hospital. Anaesth Intens Care 1993; 21: 822–827.Google Scholar
Hellier WP, Knight J, Hern J, Waddell T. Day case paediatric tonsillectomy: a review of three years experience in a dedicated day case unit. Clin Otolaryngol 1999; 24: 208–212.Google Scholar
Mitchell RB, Pereira KD, Friedman NR, Lazar RH. Outpatient adenotonsillectomy. Is it safe in children younger than 3 years? Arch Otolaryngol Head Neck Surg 1997; 123: 681–683.Google Scholar
Calder F, Hurley P, Fernandez C. Paediatric day-case surgery in a district general hospital: a safe option in a dedicated unit. Ann R Coll Surg Engl 2001; 83: 54–57.Google Scholar
Rawal N. Analgesia for day-case surgery. Br J Anaesth 2001; 87: 73–87.Google Scholar
Macintyre IM, Miles WF. Critical appraisal and current position of laparoscopic hernia repair. J R Coll Surg Edin 1995; 40: 331–336.Google Scholar
Dahl V, Raeder JC, Erno PE, Kovdal A. Pre-emptive effect of pre-incisional versus post-incisional infiltration of local anaesthesia on children undergoing hernioplasty. Acta Anaesthesiol Scand 1996; 40: 847–851.Google Scholar
Habre W, Schwab C, Gollow I, Johnson C. An audit of postoperative analgesia after pyloromyotomy. Paediatr Anaesth 1999; 9: 253–256.Google Scholar
Zitsman JL. Current concepts in minimal access surgery for children. Pediatrics 2003; 111: 1239–1252.Google Scholar
Brown RA, Millar AJ, Jee LD, Cywes S. The value of laparoscopy for impalpable testes. S Afr J Surg 1997; 35: 70–73.Google Scholar
Law GS, Perez LM, Joseph DB. Two-stage Fowler– Stephens orchiopexy with laparoscopic clipping of the spermatic vessels. J Urol 1997; 158: 1205–1207.Google Scholar
Ho D, Keneally JP. Analgesia following paediatric day-surgical orchidopexy and herniotomy. Paediatr Anaesth 2000; 10: 627–631.Google Scholar
Patel RI, Hannallah RS. Anesthetic complications following pediatric ambulatory surgery: a 3-yr study. Anesthesiology 1988; 69: 1009–1012.Google Scholar
Warner MA, Warner ME, Warner DO, Warner LO, Warner EJ. Perioperative pulmonary aspiration in infants and children. Anesthesiology 1999; 90: 66–71.Google Scholar
Engelhardt T, Strachan L, Johnston G. Aspiration and regurgitation prophylaxis in paediatric anaesthesia. Paediatr Anaesth 2001; 11: 147–150.Google Scholar
Ferrari LR, Rooney FM, Rockoff MA. Preoperative fasting practices in paediatrics. Anesthesiology 1999; 90: 978–980.Google Scholar
Schreiner MS, Nicolson SC, Martin T, Whitney L. Should children drink before discharge from day surgery? Anesthesiology 1992; 76: 528–533.Google Scholar
Jin F, Norris A, Chung F, Ganeshram T. Should adult patients drink fluids before discharge from ambulatory surgery? Anesth Analg 1998; 87: 306–311.Google Scholar
Jin F, Chung F. Multimodal analgesia for postoperative pain control. J Clin Anesth 2001; 13: 524–539.Google Scholar
Kehlet H. Acute pain control and accelerated post-operative surgical recovery. Surg Clin North Am 1999; 79: 431–443.Google Scholar