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Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

2008, Number 3

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Rev Invest Clin 2008; 60 (3)

Unexpected admission to the intensive care unit following ambulatory surgical procedures

Lozada-León D, Rodríguez CA, Cardona-Salgado G, Ávila-Funes JA

Language: Spanish
References: 32
Page: 188-196
PDF size: 76.76 Kb.


ABSTRACT

Introduction. Unexpected admission (UA) to the intensive care unit (ICU) among the ambulatory patient could be considered as an indicator of quality of attention on ambulatory services. However, the determinants associated with this rare complication are unknown. Objective. To identify the factors associated with UA to the ICU among the patients following ambulatory surgical procedures (ASP). Material and methods. Twenty one cases and 105 controls were selected from among 4,705 patients admitted for an ASP at a teaching hospital between January 2004 and May 2006. A case was that one with an UA to the ICU for monitoring and/or treatment after its ambulatory surgical procedure. Each case was paired with five controls according to type of procedure and date of accomplishment. Conditional logistic regression analyses were used to determine the potential factors associated with an UA to the ICU. Results. Cases represented 0.4% of admitted ones for an ASP. Mean age of controls were 46.9 years and 52.4% were women. There were no statistically significant differences between cases and controls in relation to several clinical, biochemical and physical status variables (comorbidity, vital signs, biochemistry, surgical procedure, anesthetic, technical anesthetic, time of surgery, surgical bleeding). Fourteen patients were less than 48 hours at the ICU and there were no deaths. Conclusions. Most of UA to the ICU seem to be based on decisions non-related to general health status of patients and these are usually preventive. This decision is not based on scientific evidence. Admission to the ICU must be based on a multidisciplinary evaluation.


REFERENCES

  1. Ford JL, Reed WA. The surgicenter. An innovation in the delivery and cost of medical care. Ariz Med 1969; 26: 801-4.

  2. White PF. Outpatient anesthesia. En: White PF (ed.). Outpatient anesthesia-an overview. 1st Ed. New York: Churchill Livingstone; 1990, p. 1-15.

  3. Garcia-Aguado R, Moro B, Martinez-Pons V, et al. The road to the standardization of ambulatory anesthesia. Rev Esp Anestesiol Reanim 2003; 50: 433-8.

  4. Keats AS. The ASA classification of physical status–a recapitulation. Anesthesiology 1978; 49: 233-6.

  5. Guía de Actuación en Cirugía Mayor Ambulatoria [Sitio en Internet]. 2002. Disponible en: http://193.145.164.73/publicaciones/ documentos/V.1699-2002.pdf [Consultado el 18 de febrero de 2008].

  6. Bryson GL, Chung F, Finegan BA, et al. Patient selection in ambulatory anesthesia - an evidence-based review: part I. Can J Anaesth 2004; 51: 768-81.

  7. Lee A, Lum ME, Perry M, et al. Risk of unanticipated intraoperative events in patients assessed at a preanaesthetic clinic. Can J Anaesth 1997; 44: 946-54.

  8. Galindo-Palazuelos M, Peraza-Sánchez M, Ramos-Goicoechea JF, et al. Resultados de un programa de cirugía mayor ambulatoria: Implicaciones en el manejo anestésico. Cir May Amb 2003; 8: 151-7.

  9. Coley KC, Williams BA, DaPos SV, et al. Retrospective evaluation of unanticipated admissions and readmissions after same day surgery and associated costs. J Clin Anesth 2002; 14: 349-53.

  10. Vaghadia H. Outcomes in outpatients—what occurs outside? Can J Anesth 1998; 45: 603-6.

  11. Chung F, Mezei G, Tong D. Adverse events in ambulatory surgery. A comparison between elderly and younger patients. Can J Anaesth 1999; 46: 309-21.

  12. Norsidah AM, Yahya N, Adeeb N, et al. Ambulatory surgery and anaesthesia in HUKM, a teaching hospital in Malaysia: the first two years experience. Med J Malaysia 2001; 56: 58-64.

  13. Westman HR. Postoperative complications and unanticipated hospital admissions. Semin Pediatr Surg 1999; 8: 23-9.

  14. Junger A, Benson M, Klasen J, et al. Influences and predictors of unanticipated admission after ambulatory surgery. Anaesthesist 2000; 49: 875-80.

  15. Fleisher LA, Pasternak LR, Lyles A. A novel index of elevated risk of inpatient hospital admission immediately following outpatient surgery. Arch Surg 2007; 142: 263-8.

  16. Junger A, Klasen J, Benson M, et al. Factors determining length of stay of surgical day-case patients. Eur J Anaesthesiol 2001; 18: 314-21.

  17. Lagoe RJ, Bice SE, Abulencia PB. Ambulatory surgery utilization by age level. Am J Public Health 1987; 77: 33-7.

  18. De la Torre A, Rubial M. Anestesia en Cirugía Ambulatoria. Criterios de Alta hospitalaria. ANALES Sis San Navarra 1999; 22(Supl. 2): 101-6.

  19. Imasogie N, Chung F. Effect of return hospital visits on economics of ambulatory surgery. Curr Opin Anaesthesiol 2001; 14: 573-8.

  20. Ansell GL, Montgomery JE. Outcome of ASA III patients undergoing day case surgery. Br J Anaesth 2004; 92: 71-4.

  21. White PF. Ambulatory anesthesia advances into the new millennium. Anesth Analg 2000; 90: 1234-5.

  22. Fernández TB, García OC, Márquez EC, et al. Caracterización de la Cirugía Mayor Ambulatoria en un Hospital General Básico. Rev Esp Salud Pública 1999; 73: 71-80.

  23. Pauly MV, Erder MH. Insurance incentives for ambulatory surgery. Health Serv Res 1993; 27: 813-39.

  24. Aylin P, Williams S, Jarman B, et al. Trends in day surgery rates. BMJ 2005; 331: 803.

  25. Giannini A, Consonni D. Physicians’ perceptions and attitudes regarding inappropriate admissions and resource allocation in the intensive care setting. Br J Anaesth 2006; 96: 57-62.

  26. Lawlor DK, Lovell MB, DeRose G, et al. Is intensive care necessary after elective abdominal aortic aneurysm repair? Can J Surg 2004; 47: 359-63.

  27. Beauregard CL, Friedman WA. Routine use of postoperative ICU care for elective craniotomy: a cost-benefit analysis. Surg Neurol 2003; 60: 483-9.

  28. Brunelli A, Pieretti P, Al Refai M, et al. Elective intensive care after lung resection: a multicentric propensity-matched comparison of outcome. Interact Cardiovasc Thorac Surg 2005; 4: 609-13.

  29. Varela G, Jiménez M, Novoa N. ¿Cuál es la estancia hospitalaria adecuada para una resección pulmonar? Arch Bronconeumol 2001; 37: 233-6.

  30. Ancona-Berk VA, Chalmers TC. An analysis of the costs of ambulatory and inpatient care. Am J Public Health 1986; 76: 1102-04.

  31. McGloin H, Adam SK, Singer M. Unexpected deaths and referrals to intensive care of patients on general wards. Are some cases potentially avoidable? J R Coll Physicians Lond 1999; 33: 255-9.

  32. Tewfik MA, Frenkiel S, Gasparrini R, et al. Factors affecting unanticipated hospital admission following otolaryngologic day surgery. J Otolaryngol 2006; 35: 235-41.




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