Postoperative Inpatient Conversions Following Ambulatory Orthopedic Surgery.

Area of Science:

• Orthopedic Surgery
• Health Services Research
• Patient Outcomes

Background:

• Ambulatory orthopedic surgery is increasing, but some patients require unplanned inpatient conversion.
• These conversions occur immediately post-surgery or within weeks via emergency department visits.

Purpose of the Study:

• To examine characteristics, comorbidities, and admission causes in patients with unanticipated inpatient conversions.
• To identify factors for strategies aimed at minimizing unplanned admissions and associated medical costs.

Main Methods:

• Retrospective analysis of a major academic medical center's billing database.
• Identified 95 immediate inpatient conversions and 84 admissions within 30 days of ambulatory surgery.
• Assessed reasons for admission, procedure/admission length, ASA score, comorbidities, and insurance type.

Main Results:

• Postoperative pain was the primary cause (57%) for immediate inpatient conversions; hypertension was the most common comorbidity (44%).
• Infection was the leading cause (25%) for admissions within 30 days; smoking was the most frequent comorbidity (46.4%).

Conclusions:

• Immediate conversions highlight the need for optimized perioperative analgesia and patient education on pain expectations.
• Late admissions underscore the importance of optimizing medical and social factors, particularly smoking cessation, before surgery.
• Addressing these factors can significantly impact healthcare expenditures and patient outcomes.