||Researchers at the University
of Pennsylvania School of Medicine have identified
risk factors that may be associated with increased rates of
hospital admission immediately 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.
||These risk factors should be considered by patients and physicians
when deciding an appropriate surgical setting, whether outpatient
or in a hospital.
||The researchers have reported
their findings in the March 19th issue of The Archives
(PHILADELPHIA) – Researchers at the University of
Pennsylvania 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. 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.
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
risk factors were assigned point values. Increased scores in this
risk index were associated with higher odds of hospital admission
following outpatient surgery.
factors include being 65 years or older, operating time longer
than 120 minutes, cardiac diagnoses, peripheral
disease, malignancy, human
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
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.”
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