The Impact of Preoperative Risk Factors on Delayed Discharge in Day Surgery: A Meta-Analysis

This study aims to evaluate and identify the main preoperative risk factors affecting the timely discharge of day surgery patients, offering evidence to enhance preoperative assessments and minimize delayed discharge.

With the widespread adoption of day surgery in global healthcare systems, ensuring timely discharge of patients post-surgery has become a critical challenge. Numerous studies have explored various preoperative risk factors influencing delayed discharge. This meta-analysis integrates existing evidence to clarify the primary preoperative risk factors.

A systematic search was conducted across the PubMed, CINAHL, Scopus, Web of Science, Embase, Cochrane Library, and CNKI databases, including all clinical studies on preoperative risk factors for day surgery published until 15 October 2024. A systematic review and random effects model were employed to aggregate data and estimate the main preoperative risk factors for day surgery.

A total of nine studies involving 41,458 patients were included. The analysis revealed statistically significant differences in the following preoperative risk factors: age (MD = 1.33, 95% CI: 0.73-1.93, p < 0.0001), body mass index (BMI) (MD = 0.69, 95% CI: 0.18-1.20, p = 0.008), the presence of chronic comorbidities (OR = 3.62, 95% CI: 2.93-4.46, p < 0.00001), the type of anesthesia (OR = 15.89, 95% CI: 7.07-35.69, p < 0.00001), a history of cardiac disease (OR = 2.46, 95% CI: 1.71-3.53, p < 0.00001), gender (OR = 3.18, 95% CI: 2.03-4.99, p < 0.00001), the expected duration of surgery (MD = 0.18, 95% CI: 0.15-0.20, p < 0.00001), complex procedures (OR = 1.78, 95% CI: 1.47-2.16, p < 0.00001), a lack of social family support (OR = 2.42, 95% CI: 1.60-3.67, p < 0.0001), and inadequate preoperative assessment (OR = 3.64, 95% CI: 2.06-6.41, p < 0.00001). There were no statistically significant differences between the delayed discharge group and the non-delayed discharge group in terms of the American Society of Anesthesiologists (ASA) classification (p = 1.00) and preoperative anxiety (p = 0.08).

This study identifies the primary preoperative risk factors for delayed discharge in day surgery, including age, high BMI, the presence of chronic comorbidities, the type of anesthesia, a history of cardiac disease, gender, the duration of surgery, the complexity of the procedure, a lack of social family support, and inadequate preoperative assessment. These findings provide a reference for preoperative assessment, highlighting the need for clinical attention to these high-risk groups during preoperative screening and management to reduce the likelihood of delayed discharge and enhance surgical safety and success rates.