Factors associated with hospitalisation after outpatient anaesthesia in paediatric surgery at the Clermont Ferrand University Hospital Centre : Research Article

Wilfrid Mbombo

doi:10.58372/2835-6276.1093

Authors

Wilfrid Mbombo

DOI:

https://doi.org/10.58372/2835-6276.1093

Keywords:

associated factors, hospitalization, anaesthesia, ambulatory surgery

Abstract

Background: Unplanned hospitalisation of children undergoing outpatient anaesthesia is a major concern for healthcare teams. This study investigated the factors associated with these hospitalisations at the Clermont Ferrand University Hospital Centre.

Methods: This is a single-centre, cross-sectional study conducted from September 1st,2021 to January 31st,2022 at the Clermont Ferrand University Hospital, ESTAING site. It involved children aged from 2 to 17 years, of ASA class I, II and III stable, anaesthetised for a scheduled outpatient procedure. Pre-, intra- and postoperative data were collected from patient registers and records and analysed with STATA version 21.0 for p <0.05, in compliance with ethical principles.

Results: Two hundred and two patients were selected and sixteen (7.9%) were hospitalised. There was no significant difference between hospitalised and non-hospitalised children in terms of socio-demographic, clinical and anaesthetic characteristics (p>0.5). The median duration of the procedure for hospitalised patients was 45 minutes compared with 30 minutes for non-hospitalised one , with a significant difference (p<0.001). In multivariate analysis, the regression model showed that 19.9% of hospitalisations could be explained by four included risk factors included risk factors, R2 = 0.173, p=0.003. Procedure duration of more than 30 minutes adjusted for age, sex and ASA class was positively associated with hospitalisation (OR=17.76 [95% CI, 1.98 - 159.05], p=0.010).

Conclusion: This study infers that only the duration of surgery influences unplanned hospitalisation in outpatient surgery in this hospital.

References

International Association for Ambularory surgery. Policy brief day surgery: making it happen. London: Br J Anaest 2007; 62:12-9.

Recommandations organisationnelles pour la chirurgie ambulatoire : Haute Autorité de Santé 2013.

Leleu L., Kraft K. Retour d’expérience en chirurgie ambulatoire. Evolutions des pratiques d’anesthésie et de chirurgie sur l’utilisation des produits de santé. 14e journée plénière de l’OMéDIT centre – Décembre 2015.

International Association for Ambulatory surgery. Enquête sur le taux de la chirurgie ambulatoire. London : IAAS ; 2009.

Taux de chirurgie ambulatoire de 2017 : un ralentissement de sa croissance qui interroge sur l’objectif de 70% en 2022. ACFA ; 2 :2018. Site internet:https://www.chirurgie-ambulatoire.org.

Adwinckle RJ, Montgomery JE. Unplanned admission rates and postdischarge complications in patients over the age of 70 following day case surgery. Anaesthesia 2004; 59: 57-9.

Tsangu J., Mboloko J., Tshimpi A., Longo B., Bulabula M., Mokassa L. et al : State of Play of Anesthesia for Outpatient Medical and Surgical Procedures in the City of Kinshasa. OJA 2022; 12:

Tran L., Theessen A., Raucoules-Aimé M. Prise en charge des patients en chirurgie ambulatoire. EMC - Anesthésie-Réanimation 2017;14(4):1-19.

Dadure C., Séguret F., Macq C., Marie A., Capdevila X. Les actes d’anesthésie réalisée chez les enfants en France en 2010. Enquête permanente exhaustive à partir des bases nationales. Ann Fr Anesth Réanim 2012 Jan ; 31 (1) : e17-20. Doi : 10.1016/j.annfar.2012.11.015.Epub2012 Dec15.

Coté CJ., Zaslavsky A., Downes JJ., Kurth CD., Welborne LG., Warner LO. Et al. Postoperative apnea in former preterm infants after inguinal herniorraphy: a combined analysis. Anesthesiology 1995; 82:809-22.

Lavin J, Lehmann D, Silva AL. Variables associées aux visites aux services d’urgences pédiatriques pour une douleur non contrôlée en postopératoire d’adénotonsillectomie. Int J Pediatr Otorhinolaryngol 2019;123:1014.doi:10.1016/j.ijporl.2019.04.038pmid:http://www.ncbi.nlm.nih.gov/pubmed/31054535

Poves-Álvarez R, Gómez-Sánchez E, Martínez-Rafael B, Bartolomé C, Alvarez-Fuente E, Muñoz-Moreno MF et al. Parental Satisfaction With Autonomous Pediatric Ambulatory Surgery Units. Qual Manag HealthCare.2021JulSep01;30(3):145152. doi:10.1097/QMH.0000000000000301. PMID: 34086652.

Minai F, Shafiq F, Rehman A. Audit of postoperative nausea and vomiting in paediatric day case surgery. J Pak Med Assoc. 2011 Mar; 61 (3):273-6. PMID: 21465944.

Marie A, Dadure C, Seguret F, Capdevila X. Un an d’anesthésie en France : Une enquête complète basée sur la base des données nationales d’information médicale (PMSI). Partie 2 : Patients extrahospitaliers. Anesth Crit Care Pain Med. 2015 Aug;34(4):199-204. doi: 10.1016/j.accpm.2015.04.002. EPUB 2015 Juil 29. PMID : 26233282.

Dahmani S., Laffargue A., Dadure C., Veyckemans F. Description of practices and complications in the French centres that participated to APRICOT: A secondary analysis. Anaesthesia Critical Care & Pain Medicine, 2019, 38, pp.637 - 645. ff10.1016/j.accpm.2019.06.001ff.ffhal-03489276.

Sawhney M., Sawhney M, VanDenKerkhof EG, Goldstein DH. Emergency department use and hospital admission in children following ambulatory surgery: a retrospective population-based cohort study. BMJ Paediatrics Open 2021;5:e001188. doi:10.1136/bmjpo-2021-001188.

Macq C, Seguret F, Bringuier S, Sola C, Capdevila X, Dadure C. Photographie de l’activité d’anesthésie pédiatrique sur une année en France. Ann Fr Anesth Réanim 2013;32:e49-53.

Van Caelenberg E, Benoit D, Verhaeghe R, Coppens M. Unanticipated admission after ambulatory surgery in the pediatric population: a single-center retrospective analysis.ActaChirBelg.2022Jun;122(3):178-184. doi:10.1080/00015458.2021.1893579. Epub 2021 Mar 8. PMID: 33641607.

Maesani M., Birenbaum A., Delerme S., Riou B., Langeron O., Le Saché F. Étude de faisabilité pour la mise en place d’une filière de chirurgie ambulatoire en urgence. In Annales françaises d'anesthésie et de réanimation. Vol. 32, No. 6, 2013 ; 392-396).

Whippey A, Kostandoff G, Ma HK, Cheng J, Thabane L, Paul J. Predictors of unanticipated admission following ambulatory surgery in the pediatric population: a retrospective case-control study. Paediatr Anaesth. 2016 Aug; 26(8):831-7. doi:10.1111/pan.12937. Epub 2016 Jun 1. PMID: 27247224.

Tillquist MN, Gabriel RA, Dutton RP, Urman RD. Incidence and risk factors for early postoperative reintubations. J Clin Anesth. 2016; 31:80-9.

Cai Y, Lopata L, Roh A, Huang M, Monteleone MA, Wang S, et coll. Factors influencing postoperative pain following discharge in pediatric ambulatory surgery patients. J Clin Anesth. 2017; 39:100-4.

Gan TJ, Meyer TA, Apfel CC, Chung F, Davis PJ, Habib AS, et al. Society for Ambulatory Anesthesia guidelines for the management of postoperative nausea and vomiting. Anesth Analg 2007;105:1615-28. [25] Kovac AL. Management of postoperative nausea and vomiting in children. Paediatr drugs 2007; 9:47-69.