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May 1997
What happens after discharge? Return hospital visits after ambulatory surgery.
Rebecca Twersky, David Fishman, Peter Homel;Anesth Analg 1997: 85: 319-24.
[ see abstract below ]
These authors performed a retrospective review of hospital records to identify the frequency of return hospital visits after ambulatory surgery in this teaching hospital-integrated ASU. 6243 patients over 12 consecutive months were reviewed. 187 returned to the same hospital within 30 days. 54% returned to the emergency room and 46% were rehospitalized. 1.3% of the total returns were for complications.
Matched case controls and multivariate analysis were used to identify factors associated with an increased likelihood of return. The urology service was identified to have a significantly higher return rate. Monitored anesthesia care was also found to predict hospital returns, but this may be related to the urology service cases.
Insurance class, day of the week, specific providers, patient age, ASA class or gender were not significant predictors of return. 41.5% of returns were for bleeding, most commonly after D&Cs, and these most commonly were as ER visits. Other reasons for return [>5%] were for fever/infection, pain, swelling [after breast surgery, urinary retention and wound disruption.
Return to the Current Literature Review Front Page, or read the abstract:
ABSTRACT
The purpose of this study was to examine the frequency of return hospital visits after ambulatory surgery discharge and to identify any predictor variables for its occurrence. A retrospective review of hospital records for all patients returning to the same hospital within 30 days after ambulatory surgery was conducted. Data on return hospital visits that resulted in rehospitalization (as an inpatient or to the ambulatory surgery unit [ASU]) or treatment as an outpatient in the emergency room were recorded.
A total of 6243 patients underwent ambulatory surgery over 12 consecutive months and 187 returned to the same hospital of which 1.3% were for complications. Of all the returns, 54% returned to the emergency room (ER) and 46% were rehospitalized as inpatients or to ASU.
To identify factors associated with an increased likelihood of return, two case controls for each return visit were obtained from medical records of ambulatory surgical patients operated on during the same time period. Results of the multivariate analysis on the matched case controls identified urology as the only significant surgical service that predicted returns. (Odds ratio 27.87; confidence interval: [CI] 3.78-74.86; P = 0.0002).
A separate analysis of the most common ASU procedures performed identified two surgical procedures that predicted hospital return as compared with overall ambulatory surgery population: patients undergoing varicocelectomy and hydrocelectomy procedures were 8.3 times more likely to return (CI 2.090-23.75; P = 0.0042); patients undergoing dilation and cutterage were three times as likely to return (CI 1.78-5.55; P = 0.0002).
Bleeding was the most common reason for all hospital returns (41.5%), with 76.5% of these patients treated and discharged through the ER. The increased likelihood of return visits after urology procedures warrants further evaluation. As patients with bleeding were most likely to return to the ER and discharged, more effective pre- and postprocedure patient education may further reduce this occurrence. Better informing patients regarding the prognosis of bleeding, and advising them of medical alternatives, could reduce inappropriate patient returns to the ER.
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