OBJECTIVE: To identify causes of unscheduled admission following ambulatory gynecologic surgery. METHODS: We compared each patient admitted on an unscheduled basis with two patients who did not require admission. Thirty demographic and clinical factors were evaluated by univariate analysis. Significant factors (P less than .05) were then analyzed using multivariate stepwise logistic regression. RESULTS: During a 4-year period, 90 patients required unscheduled admission. This represented 3.64% of 2470 patients who underwent ambulatory gynecologic surgery. Factors associated with admission by multivariate analysis included: 1) previous abdominal surgery, 2) significant medical illnesses, 3) preoperative hemoglobin concentration, 4) general anesthesia, 5) procedure length, and 6) blood loss. Sensitivity was 60.0%, specificity was 90.6%, and the overall correct rate of prediction was 80.4%. Postoperative emesis, the most common reason for unscheduled admissions, occurred in 23.4% of patients. CONCLUSIONS: Previous abdominal surgery and significant medical illnesses are factors that cannot be altered preoperatively. The need for general anesthesia, procedure length, and blood loss are functions of the procedure and cannot be easily modified. Postoperative emesis may warrant further investigation. Successful antiemetic therapy may reduce unscheduled admissions.
OBJECTIVE: To identify causes of unscheduled admission following ambulatory gynecologic surgery. METHODS: We compared each patient admitted on an unscheduled basis with two patients who did not require admission. Thirty demographic and clinical factors were evaluated by univariate analysis. Significant factors (P less than .05) were then analyzed using multivariate stepwise logistic regression. RESULTS: During a 4-year period, 90 patients required unscheduled admission. This represented 3.64% of 2470 patients who underwent ambulatory gynecologic surgery. Factors associated with admission by multivariate analysis included: 1) previous abdominal surgery, 2) significant medical illnesses, 3) preoperative hemoglobin concentration, 4) general anesthesia, 5) procedure length, and 6) blood loss. Sensitivity was 60.0%, specificity was 90.6%, and the overall correct rate of prediction was 80.4%. Postoperative emesis, the most common reason for unscheduled admissions, occurred in 23.4% of patients. CONCLUSIONS: Previous abdominal surgery and significant medical illnesses are factors that cannot be altered preoperatively. The need for general anesthesia, procedure length, and blood loss are functions of the procedure and cannot be easily modified. Postoperative emesis may warrant further investigation. Successful antiemetic therapy may reduce unscheduled admissions.
Authors: Jai Darvall; Britta Sylvia von Ungern-Sternberg; Sabine Braat; David Story; Andrew Davidson; Megan Allen; An Tran-Duy; Dana Middleton; Kate Leslie Journal: BMJ Open Date: 2019-06-12 Impact factor: 2.692