Readmission for bleeding after outpatient surgery

To examine the frequency of readmission due to surgical bleeding after ambulatory surgery.

A retrospective review of hospital records for patients readmitted to the same hospital after surgery in our Daycare centre was conducted for January 1984 to December 1992. The charts of all patients readmitted to hospital within 48 hr of surgery were examined. Readmissions for bleeding were studied with respect to demographics, time when bleeding occurred after arrival in PACU(latent interval) and treatment. Matched controls were identified and a case-control analysis performed to identify factors associated with an increased risk of readmission from bleeding.

There were 172,710 outpatient procedures and 64 readmission for bleeding (0.04%). Gynaecological and urological surgery accounted for the highest number of bleeders (86%). Most patients who bled excessively in the OR continued to bleed in PACU. Those who bled in the PACU alone had a latent interval of 54 +/- 77 min. Those who bled both in the OR and PACU had a latent interval of 20 +/- 7 min. Those who bled mainly at home had a latent interval of 104 +/- 68 min. A majority of bleeders could have been identified if they had been observed for 30-45 min. Logistic regression of case-control matches did not identify any risk factor likely to increase the risk of readmission in bleeders.

Bleeding after outpatient surgery is uncommon and discharge criteria need to be re-examined in order to take this into account and permit appropriate fast tracking of outpatients.