Unanticipated Hospital Admission after Ambulatory Surgery – A tertiary care center’s experience

Background and Goal of Study
Unanticipated hospital admission after ambulatory surgery is a clinical marker of the utmost importance often used to monitor the quality of care of ambulatory surgery units (ASU).
The main goal of this study is to determine the unanticipated hospital admission rate after ambulatory surgery in our tertiary-care center’s ASU, to define the main causes of admission and identify associated factors. 

Materials and Methods:
Authors proceeded to a retrospective analysis of the first 30 days of the postoperative period of all patients submitted to surgical procedures in the center’s ASU during one year period (January to December 2014). 

Results and Discussion
During this period, 1169 patients underwent ambulatory surgical procedures requiring anesthesia. Hospital admission rate in the first 30 days after surgery was 1,4% (n=24). Of these, 10 cases were admitted in the immediate postoperative period.
Average age was 44 years and patients were predominantly female (n=15), ASA physical score grade II (n=20) and were submitted to general anesthesia (n=17).
Reasons for unanticipated admission for these 24 patients were classified in 5 categories: surgical (n=15), medical (n=5), anesthetic (n=2) and other reasons (n=2).
Bleeding was the main surgical reason for admission and worsening of preexisting disease was the main medical one. Anesthesia related admissions were linked to drug anaphylaxis in patients with no prior history of drug allergies.
Procedure duration was over 3 hours in 4 of these cases and was the cause of 1 admission. Procedure ending time after 3pm was observed in 5 cases but in neither of them was the cause of admission. Most patients admitted underwent general surgery procedures (n=18).
In this 30 day postoperative period, 76 patients visited the emergency room (ER) but were not admitted to the hospital. Most of these patients went to ER for minor surgical complications (n=32), for follow-up surgical consultation (n=13) and for decompensation of preexisting medical conditions (n=24).

Conclusion
Reducing unanticipated hospital admissions following ambulatory surgery can only be met by periodic analysis of each centers context and limitations. These are essential to maintain high quality and safety standards.

Unanticipated hospital admission after ambulatory surgery - a tertiary care center's experience