Factors Precipitating Overnight Admission After Sialolithectomy

To determine factors predicting overnight admission after sialolithectomy.

Quality outcome database research.

The National Surgical Quality Improvement Program American College of Surgeons Participant User Files.

Current Procedural Terminology (CPT) codes 42330, 42335, and 42340 between 2007, and 2020 resulted 916 cases. Correlations between perioperative factors and overnight admission (ie, length of stay >0 days) were tested. Cases were stratified into endoscopic (ES) and nonendoscopic (NES) procedures using concurrent CPT codes 42660, 42669, and 42650.

After sialolithectomy, 13.7% (126 cases) were admitted at least overnight. Upon multivariate analysis, wound Class 4 (odds ratio [OR]: 2.15, 95% confidence interval: 1.05, 4.40), American Society of Anesthesiologists (ASA) 3 classification (OR: 2.17, 1.06-4.46, P = .035), and the operative time (OR: 1.01 [1.01-1.01], P < .001) correlated with overnight stay; while Class 2 wounds had a lower risk of overnight admission (OR: 0.31 [0.12-1.63], P < .001). The ES cohort had longer operative times (56.1 vs 73.6 minutes). In the NES cohort's multivariate analysis, ASA III (OR: 2.459 [1.13, 5.34], P < .001) and operative time (OR: 1.01 [1.01, 1.02], P < .001) correlated with overnight stay while Class 2 wound classifications protected against overnight stay (OR: 0.28 [0.15, 0.52], P < .001).

This study highlights the correlation between intraoperative complexity, as operative time, wound classification and ASA Class 3, and the need for admission after a typically ambulatory sialolithectomy. The significantly longer operative time with evidence of a shorter length of stay in ES cases suggests a valuable trade off, within the limits of indication.