What happens after discharge? Return hospital visits after ambulatory surgery

The purpose of this study was to examine the frequency of return hospital visits after ambulatory surgery discharge and to identify any predictor variables for its occurrence. A retrospective review of hospital records for all patients returning to the same hospital within 30 days after ambulatory surgery was conducted. Data on return hospital visits that resulted in rehospitalization (as an inpatient or to the ambulatory surgery unit [ASU]) or treatment as an outpatient in the emergency room were recorded. A total of 6243 patients underwent ambulatory surgery over 12 consecutive months and 187 returned to the same hospital of which 1.3% were for complications. Of all the returns, 54% returned to the emergency room (ER) and 46% were rehospitalized as inpatients or to ASU. To identify factors associated with an increased likelihood of return, two case controls for each return visit were obtained from medical records of ambulatory surgical patients operated on during the same time period. Results of the multivariate analysis on the matched case controls identified urology as the only significant surgical service that predicted returns. (Odds ratio 27.87; confidence interval [CI] 3.78-74.86; P = 0.0002). A separate analysis of the most common ASU procedures performed identified two surgical procedures that predicted hospital return as compared with overall ambulatory surgery population: patients undergoing varicocelectomy and hydrocelectomy procedures were 8.3 times more likely to return (CI 2.090-23.75; P = 0.0042); patients undergoing dilation and curettage were three times as likely to return (CI 1.78-5.55; P = 0.0002). Bleeding was the most common reason for all hospital returns (41.5%), with 76.5% of these patients treated and discharged through the ER. The increased likelihood of return visits after urology procedures warrants further evaluation. As patients with bleeding were most likely to return to the ER and discharged, more effective pre- and postprocedure patient education may further reduce this occurrence. Better informing patients regarding the prognosis of bleeding, and advising them of medical alternatives, could reduce inappropriate patient returns to the ER.