Day surgery in children: 15-year analysis of unplanned admissions at a Japanese tertiary children’s hospital

TL;DR

A 15-year study in Japan found that unplanned hospital admissions after pediatric day surgery are rare but often linked to anesthesia issues and late operating room exits.

Contribution

The study identifies specific risk factors and management strategies for unplanned admissions after pediatric day surgery in Japan.

Findings

Unplanned hospital admission occurred in 0.19% of pediatric day surgery cases.

Postoperative nausea and vomiting was the most common cause of unplanned admissions.

Longer operation time and late exit from the operating room were significant risk factors.

Abstract

Unplanned hospital admission following pediatric day surgery is a crucial quality indicator. This study examined the incidence, related risks, interventions, and outcomes of unplanned hospital admission following pediatric day surgery among children in Japan.

This single-center, retrospective study analyzed data of 14,529 pediatric patients under the age of 18 years who underwent day surgery between August 2007 and December 2022. Unplanned hospital admission was defined as an overnight hospital stay that was not planned preoperatively, including patients who returned to the emergency department and required admission within 24 h of discharge. Reasons for unplanned hospital admission and interventions were categorized, and risk factors were identified using logistic regression.

The incidence of unplanned hospital admission was 0.19%. The most common reasons for unplanned hospital admission were anesthetic-related, particularly postoperative nausea and vomiting (36%), which was managed primarily with intravenous fluids (36%) and antiemetic medications (21%). Medical and surgical factors were next most common. Logistic regression identified longer operation time (adjusted Odds ratio 1.03; 95% confidence interval [1.01, 1.04]; P < 0.001) and exit from the operating room after 15:00 (adjusted Odds ratio 29.3; 95% confidence interval [7.09, 121]; P < 0.001) as significant risk factors for unplanned hospital admission.

Unplanned hospital admission was most commonly anesthetic-related and was managed with intravenous fluids and antiemetic medications. Longer operation time and later exit from the operating room were significant risk factors. These findings can guide targeted strategies to further reduce unplanned hospital admission and improve pediatric day surgery quality.

Figures