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Risk Factors Leading to Overnight Stays in Pediatric Surgical Outpatients
Marko Bašković1,2,3, Martina Markanović1,4, Sanja Ivanović1,4
1Department of Pediatric Surgery, Children's Hospital Zagreb, Ulica Vjekoslava Klaića 16, 10000 Zagreb, Croatia.
Insights
Longer surgery duration is a key factor predicting hospitalization for pediatric same-day surgery patients. Further research is needed to fully understand predictors for same-day surgery outcomes in children.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Health Services Research
Background:
- Same-day surgery aims for patient discharge on the same postoperative day.
- Identifying factors preventing same-day discharge in pediatric patients is crucial for optimizing surgical pathways.
Purpose of the Study:
- To determine predisposing factors associated with failure to discharge pediatric patients on the same day after surgery.
Main Methods:
- Retrospective review of electronic health records from a children's hospital's Day Surgery Unit (2021-2023).
- Comparison of patients not discharged same-day (n=68) with a control group discharged same-day (n=68), matched for age and gender.
- Analysis of surgical and anesthetic variables, including anesthesia type, analgesia, operating room times, and surgery duration.
Main Results:
- Statistically significant differences observed in anesthesia type, analgesic use, operating room entry/exit times, and surgery duration between groups.
- Surgery duration was significantly longer in patients requiring hospitalization (76.81 ± 37.21 min) compared to same-day discharge (46.51 ± 22.46 min).
- Regression analysis indicated that surgery duration (p = 0.004) was the only significant predictor, explaining 38% of hospitalization variability.
Conclusions:
- Surgery duration emerged as the primary predictor for hospitalization following pediatric same-day surgery.
- Limited existing research, particularly in the pediatric population, highlights the need for further multicenter studies.
- Further investigation is warranted to refine understanding and improve outcomes for pediatric same-day surgery.
Background:
Same-day surgery implies patient discharge on the same day after the surgery. The main aim of the research was to determine which predisposing factors lead to children treated with same-day surgery not being able to be discharged on the same day.
Methods:
For the purposes of this research, the electronic records of patients in the hospital information system were reviewed retrospectively. The search included patients who were surgically treated through the Day Surgery Unit at the Children's Hospital Zagreb with various diagnoses from 1 January 2021 to 31 December 2023. The target group consisted of patients who could not be discharged on the same day (n = 68), while for the purposes of the control group (n = 68), patients were randomly selected, comparable by age and gender, who were discharged from the hospital on the same day in accordance with the principles of same-day surgery.
Results:
In relation to the parameters of interest between the groups, statistically significant differences were observed in the type of general anesthesia (p = 0.027), the use of analgesics (p = 0.016), the time of entering the operating room (p = 0.000), the time of leaving the operating room (p < 0.0001) and the duration of surgery (76.81 ± 37.21 min vs. 46.51 ± 22.46 min, p < 0.0001). When explanatory variables were included in the regression model, they explained 38% of the variability in the dependent variable. Only the variable "duration of surgery" provided significant information to explain the variability in the dependent variable (p = 0.004).
Conclusions:
Although the duration of surgery was imposed as the main predictor of hospitalization after same-day surgery, and considering the extremely small number of studies on the mentioned topic, especially in the pediatric population, further, preferably multicenter research on the mentioned topic is needed.
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