Abstract
Background
Same-day surgery is an increasingly utilized and cost-effective strategy to manage
common surgical conditions. However, many institutions limit ambulatory surgical services
to only healthy individuals. There is also a paucity of data on the safety of same-day
discharge among high-risk patients. This study aims to determine whether same-day
discharge is associated with higher major morbidity and readmission rates compared
with overnight stay in high-risk general surgery patients.
Methods
This is a retrospective cohort using the data from the National Surgical Quality Improvement
Program from 2005 to 2017. Patients with an American Society of Anesthesiologists
class ≥3 undergoing general surgical procedures amenable to same-day discharge were
identified. Primary and secondary outcomes were major morbidity and readmission at
30 d. A multivariable logistic regression model using mixed effects was used to adjust
for the effect of same-day discharge.
Results
Of 191,050 cases, 137,175 patients (72%) were discharged on the same day. At 30 d,
major morbidity was 1.0%, readmission 2.2%, and mortality <0.1%. Adjusted odds ratio
of same-day discharge was 0.59 (95% confidence interval 0.54-0.64; P < 0.001) for major morbidity and 0.75 (95% confidence interval 0.71-0.80; P < 0.001) for readmission. Significant risk factors for morbidity and readmission
included nonindependent functional status, ascites, renal failure, and disseminated
cancer.
Conclusions
Major morbidity and readmission rates are low among this large sample of high-risk
general surgery patients undergoing common ambulatory procedures. Same-day discharge
was not associated with increased adverse events and could be considered in most high-risk
patients after uncomplicated surgery.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Surgical ResearchAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Postoperative recovery and discharge.Anesthesiol Clin North Am. 2003; 21: 367-386
- Chapter 3: Utilization and Volume. Trends Affecting hospitals and health Systems.(Available at:)https://www.aha.org/guidesreports/2018-05-23-trendwatch-chartbook-2018-chapter-3-utilization-and-volumeDate accessed: September 1, 2019
- Surgeries in hospital-based ambulatory surgery and hospital inpatient settings, 2014: statistical brief #223.in: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Agency for Healthcare Research and Quality (US), Rockville, MD2006
- Ambulatory surgical centers: a review of complications and adverse events.J Am Acad Orthop Surg. 2017; 25: 12-22
- High risk patients in day surgery.Minerva Anestesiol. 2009; 75: 259-268
- Hospital resources used for inpatient and ambulatory surgery.Anesthesiology. 1988; 69: 383-386
- Ambulatory surgery centers and their intended effects on outpatient surgery.Health Serv Res. 2015; 50: 1491-1507
- Ambulatory surgery adult patient selection criteria - a survey of Canadian anesthesiologists.Can J Anaesth. 2004; 51: 437-443
- Major morbidity and mortality within 1 month of ambulatory surgery and anesthesia.JAMA. 1993; 270: 1437-1441
- Return hospital visits and morbidity within 60 days after day surgery: a retrospective study of 18,736 day surgical procedures.Acta Anaesthesiol Scand. 2006; 50: 911-919
- Patient selection for day case-eligible surgery: identifying those at high risk for major complications.Anesthesiology. 2013; 119: 1310-1321
- Retrospective evaluation of unanticipated admissions and readmissions after same day surgery and associated costs.J Clin Anesth. 2002; 14: 349-353
- What happens after discharge? Return hospital visits after ambulatory surgery.Anesth Analg. 1997; 84: 319-324
- The Department of Veterans Affairs' NSQIP: the first national, validated, outcome-based, risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care. National VA Surgical Quality Improvement Program.Ann Surg. 1998; 228: 491-507
- The patient safety in surgery study: background, study design, and patient populations.J Am Coll Surg. 2007; 204: 1089-1102
- Risk adjustment of the postoperative morbidity rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study.J Am Coll Surg. 1997; 185: 328-340
- Multiple Imputation for Nonresponse in Surveys.Wiley, New York1987
- Anesthesia for ambulatory surgery.Korean J Anesthesiol. 2017; 70: 398-406
- Guidelines for day-case surgery 2019.Anaesthesia. 2019; 74: 778-792
- Mortality in outpatient surgery.Plast Reconstr Surg. 2008; 122 (discussion 251-243): 245-250
- Inpatient hospital admission and death after outpatient surgery in elderly patients: importance of patient and system characteristics and location of care.Arch Surg. 2004; 139: 67-72
- Improving outcomes in ambulatory anesthesia by identifying high risk patients.Curr Opin Anaesthesiol. 2018; 31: 1
- National surgical quality improvement program (NSQIP) risk factors can be used to validate American Society of Anesthesiologists Physical Status classification (ASA PS) levels.Ann Surg. 2006; 243 (discussion 641-634): 636-641
- Outcome of ASA III patients undergoing day case surgery.Br J Anaesth. 2004; 92: 71-74
- A novel index of elevated risk of inpatient hospital admission immediately following outpatient surgery.Arch Surg. 2007; 142: 263-268
- Factors affecting recovery and discharge following ambulatory surgery.Can J Anaesth. 2006; 53: 858-872
- Day-case versus overnight stay in laparoscopic cholecystectomy.Cochrane Database Syst Rev. 2008; : CD006798
- Outcomes in day surgery.Curr Opin Anaesthesiol. 2006; 19: 622-629
- Predictors of unanticipated admission following ambulatory surgery: a retrospective case-control study.Can J Anaesth. 2013; 60: 675-683
- Return hospital visits and hospital readmissions after ambulatory surgery.Ann Surg. 1999; 230: 721-727
- A meta-analysis of ambulatory versus inpatient laparoscopic cholecystectomy.Surg Endosc. 2008; 22: 1928-1934
- Analysis of failed discharge after ambulatory surgery: unanticipated admission.Acta Chir Belg. 2019; 119: 139-145
Article info
Publication history
Published online: February 24, 2021
Accepted:
January 22,
2021
Received in revised form:
January 19,
2021
Received:
November 24,
2020
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
