Unplanned overnight hospital admission after strabismus surgery

To examine the reasons for unplanned overnight hospital admission in paediatric patients undergoing strabismus repair, to identify preventable causes (particularly postoperative nausea and vomiting), and to compare the rate of unplanned overnight stay with a group undergoing inguinal hernia repair.

A retrospective review of consecutive patients under age 17 having strabismus surgery over a 5-year period between January 1995 and December 1999 was undertaken at Christchurch Hospital, New Zealand. A control group, from a similar period, of children having elective inguinal hernia repair was used to compare the rate of overnight stay.

375 patients had strabismus surgery, of which 51 stayed overnight; 19 of these were from remote locations and stayed for geographic reasons only, 9 stayed overnight preoperatively only, thus leaving an unplanned overnight stay rate of 6.4%. This compared to a rate of 1.1% in those having hernia surgery. The reasons for overnight stay were postoperative nausea and vomiting (50%), anaesthetic complications (18%), late afternoon surgery (14%), social factors (14%), and pain (5%). Significant associations were found between postoperative nausea and vomiting and the extent and duration of surgery. Possible associations not reaching significance included a higher rate of postoperative nausea and vomiting in those receiving nitrous oxide, and those with evidence of stimulation of the oculo-cardiac reflex.

The provision of suitable accommodation and careful planning of the type and timing of surgery would be expected to reduce the overnight stay rate after strabismus surgery.