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Predictors of unanticipated admission following ambulatory surgery in the pediatric population: a retrospective
Amanda Whippey1, Gregory Kostandoff1, Heung K Ma1
1Department of Anesthesia, McMaster University, Hamilton, ON, Canada.
Insights
Pediatric ambulatory surgery has a low rate of unanticipated hospital admissions. Key risk factors include younger age, higher ASA class, longer surgery duration, and specific procedures like ENT or orthopedic, with intraoperative events and obstructive sleep apnea (OSA) being significant.
Area of Science:
- Pediatric Anesthesiology
- Surgical Outcomes Research
Background:
- Ambulatory surgery is crucial in pediatric anesthesia, but predicting complications remains challenging.
- Adult studies identify predictors like age, ASA class, surgery duration, and BMI for unanticipated admission.
- This study retrospectively analyzes risk factors for unanticipated admission in pediatric ambulatory surgery.
Purpose of the Study:
- To identify risk factors associated with unanticipated hospital admission in children undergoing ambulatory surgery.
- To compare predictors of admission in pediatric patients with those identified in adult populations.
Main Methods:
- A case-control study comparing pediatric ambulatory surgery patients with unanticipated admissions to a control group without admissions (2005-2013).
- Data collected included demographics, surgical details, medications, intraoperative events, and comorbidities.
- Multiple conditional logistic regression analysis was employed to determine associated factors.
Main Results:
- The incidence of unanticipated admission was 0.97%, with 47% being anesthesia-related.
- Significant risk factors included: age <2 years (OR 4.26), ASA class 3 (OR 3.77), surgery duration >1 hour (OR 6.54), surgery completion after 3 pm (OR 2.17), orthopedic (OR 2.52), ENT (OR 6.47) surgery, intraoperative events (OR 4.45), and obstructive sleep apnea (OSA) (OR 6.32).
- Dental surgery showed a protective effect (OR 0.21).
Conclusions:
- Unanticipated hospital admission following pediatric ambulatory surgery is infrequent.
- Age, ASA class, surgery duration, and completion time are common predictors for both pediatric and adult patients.
- Intraoperative complications, OSA, and specific surgical types (ENT, orthopedic, dental) are pediatric-specific predictors.
Background:
Ambulatory surgery plays an important role in pediatric anesthesia. However, it is difficult to predict which patients will experience complications. Age >80, ASA class 3 or 4, duration of surgery >3 h, and BMI 30-35 are independent predictors of unanticipated admission in adults. In this study, we retrospectively evaluate risk factors for unanticipated admission, following ambulatory surgery in children.
Methods:
All ambulatory patients requiring unanticipated admission between 2005 and 2013 were compared to a random sample of patients not requiring admission in this case-control study. Demographic data, surgical information, medications, intraoperative events, and patient comorbidities were collected from both groups. The reason for admission was classified according to five subtypes. Multiple conditional logistic regression was used to assess factors associated with unanticipated admissions.
Results:
The incidence of unanticipated admission was 0.97% (213). Of these, 47% (98) was anesthesia related. Age <2 years (odds ratio [OR] 4.26 95% CI 1.19-15.25), ASA 3 class (OR 3.77 95% CI 1.46-9.71), duration of surgery >1 h (OR 6.54 95% CI 3.47-12.33), completion of surgery >3 pm (OR 2.17 95% CI 1.05-4.51), orthopedic (OR 2.52 95% CI 1.03-6.20), dental (OR 0.21 95% CI 0.06-0.81), ENT (OR 6.47 95% CI 2.99-14.03) surgery, intraoperative events (OR 4.45 95% CI 1.35-18.12), and OSA (OR 6.32 95% CI 1.54-25.94) were factors associated with unanticipated admission.
Conclusion:
The incidence of unanticipated admission in children following ambulatory surgery is low. Age, ASA class, duration, and time of completion of surgery are predictors common to pediatrics and adults. Interestingly, intraoperative complications, OSA, and type of surgery (ENT, orthopedic, dental) are specific to pediatrics.
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