Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-11-23T02:00:13.305Z Has data issue: false hasContentIssue false
  • English
  • Français

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
Get access

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

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