Researchers at the University of Pennsylvania's School of Medicine have identified risk factors that may be associated with increased rates of hospital admission immediately following outpatient surgery. These risk factors should be considered by patients and physicians when deciding an appropriate surgical setting, whether outpatient or in a hospital.
"This study shows we can assess the risk for a patient to have surgery away from a hospital where emergency services are close at hand," said Fleisher. "Most complications from outpatient surgery are minor. But if there is something major would you rather be far away and need to call a ambulance and be transported varying distances to a hospital or would you rather have a full staff of physicians in the building and ready to help treat you?
The study consisted of 783,558 ambulatory surgery patients, of which 4,351 were sent directly to hospital following surgery, and of which 19 died. This equates to only 1 death per approximately 50,000 patients.
Medical risk factors were assigned point values. Increased scores in this risk index were associated with higher odds of hospital admission following outpatient surgery. Risk factors include being 65 years or older, operating time longer than 120- minutes, cardiac diagnoses, peripheral vascular disease, cerebrovascular disease, malignancy, human immunodeficiency virus, and regional or general anesthesia.
"I believe outpatient surgery is very safe, however, as the practice gains in popularity, the risk factors for certain patients should be weighed," said Fleisher. "It is the responsibility of both the patient and the physician to consider the medical history and type of procedure before deciding what is best to ensure a healthy outcome."
Medical procedure restrictions are being lifted and more and more procedures are being done on an outpatient basis.
Some of these facilities are far from hospitals, which adds to the patient's risk should complications arise.
Some anomalies in the study exist. For example, there was no association between outpatient cataract surgery and immediate hospitalization due to the very low-risk of the procedure. On the other hand, postoperative nausea and vomiting constitute one of the most common causes of admission, but are common in patients who undergo general anesthesia, which may account for the increased risk in this category.
Surgery in freestanding surgery centers has many advantages, especially from a patient comfort standpoint. Close proximity to the surrounding community, more patient friendly services, such as parking and in some cases a more procedure specific focus are all plusses of the outpatient setting. However, ambulatory settings don't have nearly the variety and expertise offered at a hospital."We know about 1 in 200 patients get admitted to hospital following outpatient surgery, but that rate can easily vary," Fleisher concludes. "Outpatient surgery centers are going to continue pushing the envelope and it is imperative that patients and physicians take control back. We have some steps in place now that can help in the decision making process. We need to carefully review them and make sure we do what's best for our patients regardless of the convenience factor."
Corresponding Author Lee A. Fleisher, MD, FACC, FAHA, Chair of Anesthesiology and Critical Care for the University of Pennsylvania Health System and colleagues report their findings in the March 19th issue of The Archives of Surgery.
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