| Abstract: |
A retrospective review of ambulatory surgery admissions during a 12-month period was undertaken in seven hospital-based ambulatory surgery units to identify variables that contributed to hospital admissions and to make recommendations to reduce avoidable admissions further. Out of 32 457 ambulatory surgery patients, 3.2% were admitted (1042), with a range of 0.9-9.4% across the seven hospitals. When controlling for hospital differences, urological surgery had the highest admission rate (6.1%) compared to other surgical specialities and emerged as a significant predictor of hospital admission (P < 0.001, odds ratio 3.9, 95% confidence interval (CI) 3.28-4.56). Both regional and general anaesthesia were significant predictors of admission and had proportionally higher admission rates (4.7 and 4.2% respectively, P < 0.05) compared to monitored anaesthesia care (MAC) and local anaesthesia (1.3 and 0.6% respectively, P < 0.05). Admission rate was the same for ASA I-III patients. Admissions were regrouped into unavoidable reasons - 58%, potentially avoidable admissions - 23% and avoidable - 16%. Main predictors of avoidable admission were duration of surgery (P < 0.001) and female gender (P < 0.037). As close to 40% of admissions may be avoidable, efforts toward their reduction should be directed at scheduling cases that are reasonably likely to require extensive surgery on an inpatient or less than 24 h observation basis, and by prioritizing outpatient cases in an integrated operating suite. © 1995. |
