Background and Goal of Study: Outpatient surgery is increasing in variety and number and is accepting higher risk patients. It’s important to assess the unplanned admission rate to improve the quality of ambulatory surgical units. The goal of this study is to determine the number and reasons of unanticipated admissions in our surgical day care unit, to improve quality of care and avoid adverse events in the future.
Materials and Methods: A retrospective clinic audit of all unanticipated admissions over a 10-year period to was done. Ambulatory surgical unit (ASU) records and IBM SPSS statistics 22 were used. Unanticipated admission is defined as unplanned admission after a day procedure, excluding prior discharge. Variables recorded: demographic data, American Society of Anaesthesiology (ASA) physical status classification, type of surgery and anaesthesia, procedure duration and reasons for hospital admission.
Results and discussion: Over the 10-year period, 210 unplanned admissions were registered after ambulatory surgery, out of a total of 51097 patients operated in our ASU (0,41%). 55% were female and general anaesthesia was used in 68,6%. Patient median age was 58 years, with 30% of patients over 65 years. ASA physical status classification was II/III in 65,7/14,8%. Procedures were from the following surgical specialties: general surgery 40,9%, gynaecology 20,5%, ophthalmology 10%, orthopaedics 8,6%, gastroenterology 8,6%, urology 6,2% and others 5,2%. Gynaecology had the highest (1,66%) relative rate of admission, followed by general surgery 1,08%, neurosurgery 1,05% and urology 0,98%. Surgical procedures among admissions were cataract surgery (17%), inguinal hernia repair (16%), and hysteroscopy (4,8%). Procedure median duration was 48 minutes. Most admissions were surgery related (59%) with the major reasons being a more extensive surgery than planned and surgical complications, followed by anaesthesia related issues (24,3%), where pain was the major reason and social/miscellaneous reasons (16,7%). In most cases, hospital stay was 2 days.
Conclusion: Our unplanned admission rate was 0,41%, which is lower than rates reported in the literature (<2%). This result further supports that ambulatory surgery is a safe practice. It’s essential to monitor unplanned admission rates to maintain a high quality of care, ensuring cost efficiency and patient satisfaction.

06 / Unanticipated admission after ambulatory surgery: 10 year retrospective audit