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Unplanned admissions after day-case surgery in an Italian third-level pediatric hospital: a retrospective study
Alessandro Vittori1, Luigi Tritapepe2,3, Fabrizio Chiusolo4
1Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy. alexvittori82@gmail.com.
Insights
Day-case surgery can be safe and cost-effective in pediatrics. An educational program and careful patient selection in Italian pediatric day-case surgery resulted in a very low unplanned admission rate.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Health Services Management
Background:
- Day-case surgery offers cost savings without compromising safety.
- An educational program was implemented at Ospedale Pediatrico Bambino Gesù for staff and families.
- Unplanned admission rates are a key quality indicator for pediatric day-case surgery.
Purpose of the Study:
- To evaluate the unplanned admission rate after day-case surgery in a pediatric setting.
- To assess the safety and efficacy of an educational program for day-case surgery.
- To provide Italian data on pediatric day-case surgery outcomes.
Main Methods:
- Retrospective analysis of hospital database records.
- Focus on pediatric patients requiring unplanned overnight admission.
- Data collected from September 2012 to April 2018.
Main Results:
- 8,826 general anesthesia procedures were performed across various surgical specialties.
- Anesthetic-related unplanned admissions were minimal (0.023%), with two cases (syncope, vomit).
- No major complications were reported.
Conclusions:
- High-quality patient selection is crucial for safe day-case surgery.
- An integrated approach including facility safety, family education, and staff training enhances anesthetic safety.
- The findings support the safety and efficiency of pediatric day-case surgery with appropriate protocols.
Background:
Increasing procedures in day-case surgery can mitigate the costs of health service, without reducing safety and quality standards. The Ospedale Pediatrico Bambino Gesù has adopted an educational program for healthcare personnel and patients' families to increase the number of day-case surgery procedures performed without reducing the level of safety. The unplanned admission rate after day-case surgery can be a quality benchmark for pediatric day-case surgery, and in literature, there are no Italian data.
Methods:
We made a retrospective analysis of the hospital database and focused on children requiring unplanned admission to the central venue of the hospital for the night. The audit covered the period from September 2012 to April 2018.
Results:
We performed general anesthesia for 8826 procedures (urology 33.60%, plastic surgery 30.87%, general surgery 17.44%, dermatology 11.66%, dentistry 3.16%, orthopedics 1.64%, digestive endoscopy 1.63%). Unplanned admission for anesthetic reasons resulted in two cases: one case of syncope and one case of vomit (0.023% rate). No one major complication.
Conclusions:
Good quality of patient selection, the safety of the structure, family education, and an efficient organizational model combined with an educational program for anesthesiologists can improve the safety of anesthesia for day-case surgery.
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