naa a22 4500 510743307 CHVBK 20180411083036.0 cr unu---uuuuu 180411e20130701xx s 000 0 eng 10.1007/s12630-013-9935-5 doi (NATIONALLICENCE)springer-10.1007/s12630-013-9935-5 Predictors of unanticipated admission following ambulatory surgery: a retrospective case-control study [Elektronische Daten] [Amanda Whippey, Greg Kostandoff, James Paul, Jinhui Ma, Lehana Thabane, Heung Ma] Les prédicteurs d'une admission non anticipée après une chirurgie ambulatoire: une étude cas-témoin rétrospective Purpose: The primary objectives of this historical case-control study were to evaluate the incidence of and reasons and risk factors for adult unanticipated admissions in three tertiary care Canadian hospitals following ambulatory surgery. Methods: A random sample of 200 patients requiring admission (cases) and 200 patients not requiring admission (controls) was taken from 20,657 ambulatory procedures was identified and compared. The following variables were included: demographics, reason for admission, type of anesthesia, surgical procedure, length of procedure, American Society of Anesthesiologists' (ASA) classification, surgical completion time, pre-anesthesia clinic, medical history, medications (classes), and perioperative complications. Multiple logistic regression analysis was used to assess factors associated with unanticipated admissions. Results: The incidence of unanticipated admission following ambulatory surgery was 2.67%. The most common reasons for admission were surgical (40%), anesthetic (20%), and medical (19%). The following factors were found to be associated with an increased risk of unanticipated admission: length of surgery of one to three hours (odds ratio [OR] 16.70; 95% confidence interval [CI] 4.10 to 67.99) and length of surgery more than three hours (OR 4.26; 95% CI 2.40 to 7.55); ASA class III (OR 4.60; 95% CI 1.81 to 11.68); ASA class IV (OR 6.51; 95% CI 1.66 to 25.59); advanced age (>80 yr) (OR 5.41; 95% CI 1.54 to 19.01); and body mass index (BMI) of 30-35 (OR 2.81; 95% CI 1.31 to 6.04). Current smoking status was found to be associated with a decreased likelihood of unanticipated admission (OR 0.44; 95% CI 0.23 to 0.83), as was monitored anesthesia care when compared with general anesthesia (OR 0.17; 95% CI 0.04 to 0.68) and plastic (OR 0.18; 95% CI 0.07 to 0.50), orthopedic (OR 0.16; 95% CI 0.08 to 0.33), and dental/ear-nose-throat surgery (OR 0.32; 95% CI 0.13 to 0.83) when compared with general surgery. Other comorbid conditions did not impact unanticipated admission. Conclusion: Unanticipated admission after ambulatory surgery occurs mainly due to surgical, anesthetic, and medical complications. Length of surgery more than one hour, high ASA class, advanced age, and increased BMI were all predictors. No specific comorbid illness was associated with an increased likelihood of unanticipated admission. These findings support continued use of the ASA classification as a marker of patient perioperative risk rather than attributing risk to a specific disease process. Canadian Anesthesiologists' Society, 2013 Whippey Amanda Department of Anesthesia, McMaster University, Hamilton, ON, Canada aut Kostandoff Greg Department of Anesthesia, McMaster University, Hamilton, ON, Canada aut Paul James Department of Anesthesia, McMaster University, Hamilton, ON, Canada aut Ma Jinhui Department of Clinical Epidemiology and Biostatistics, Biostatistics Unit, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada aut Thabane Lehana Department of Anesthesia, McMaster University, Hamilton, ON, Canada aut Ma Heung Department of Anesthesia, McMaster University, Hamilton, ON, Canada aut Canadian Journal of Anesthesia/Journal canadien d'anesthésie Springer-Verlag 60/7(2013-07-01), 675-683 0832-610X 60:7<675 2013 60 12630 https://doi.org/10.1007/s12630-013-9935-5 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12630-013-9935-5 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Whippey Amanda Department of Anesthesia, McMaster University, Hamilton, ON, Canada aut NATIONALLICENCE 700 1- Kostandoff Greg Department of Anesthesia, McMaster University, Hamilton, ON, Canada aut NATIONALLICENCE 700 1- Paul James Department of Anesthesia, McMaster University, Hamilton, ON, Canada aut NATIONALLICENCE 700 1- Ma Jinhui Department of Clinical Epidemiology and Biostatistics, Biostatistics Unit, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada aut NATIONALLICENCE 700 1- Thabane Lehana Department of Anesthesia, McMaster University, Hamilton, ON, Canada aut NATIONALLICENCE 700 1- Ma Heung Department of Anesthesia, McMaster University, Hamilton, ON, Canada aut NATIONALLICENCE 773 0- Canadian Journal of Anesthesia/Journal canadien d'anesthésie Springer-Verlag 60/7(2013-07-01), 675-683 0832-610X 60:7<675 2013 60 12630 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer