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A prospective study of factors associated with delayed discharge in school-aged children undergoing ward-based minor
1Department of Nursing and Midwifery Studies, Medical School, Queens Medical Centre, Nottingham, U.K.
Insights
Many children undergoing day-case surgery unexpectedly stayed overnight. Older age, pre-operative anxiety, and social factors were linked to these extended pediatric stays, impacting the efficiency of day-case procedures.
Area of Science:
- Pediatric Surgery
- Healthcare Management
- Child Psychology
Background:
- Day-case surgery is intended for same-day discharge.
- A significant number of pediatric patients experience overnight stays post-procedure.
- Understanding factors influencing extended stays is crucial for optimizing surgical pathways.
Purpose of the Study:
- To investigate the rate and predictors of overnight stays in children undergoing day-case surgery.
- To compare the characteristics of children discharged on the day of surgery versus those requiring an overnight stay.
- To assess the psychological outcomes of children following day-case surgery, comparing day-stay and inpatient groups.
Main Methods:
- Retrospective analysis of 93 children (aged 5-12 years) undergoing day-case procedures.
- Data collection on patient demographics, surgical timing, pre-operative anxiety, social factors, and medication.
- Follow-up assessment of psychological outcomes for both groups.
Main Results:
- A high rate of unplanned overnight stays was observed.
- Older children, those with later surgery times, higher pre-operative anxiety, and negative school experiences were more likely to be detained.
- Social factors, maternal anxiety, and pre-medication also predicted delayed discharge.
Conclusions:
- Ward-based day-case surgery presents challenges leading to extended pediatric stays.
- While psychological outcomes were similar at follow-up, the process highlighted inefficiencies in the day-case model.
- Identifying predictors can help improve patient selection and streamline day-case surgical pathways for children.
Abstract:
This study found a high rate of post-operative overnight stay in a group of 93 children aged between 5 and 12 years admitted to a paediatric ward for day-case procedures. Those children detained were older, had had later operations, were more worried pre-operatively and had been less happy about going to school than were children discharged on the day of surgery. Social factors, maternal worries and pre-medication also predicted delayed discharge. At a follow-up there were no differences between the day-case and in-patient groups in terms of children's psychological outcome but difficulties associated with ward-based day-case surgery were highlighted.