Retrospective evaluation of unanticipated admissions and readmissions after same day surgery and associated costs
Retrospective evaluation of unanticipated admissions and readmissions after same day surgery and associated costs
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DOI：
10.1016/s0952-8180(02)00371-9
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发表时间：
2002-08-01
影响因子：
6.7
通讯作者：
Smith, RB
中科院分区：
文献类型：
--
作者：
Coley, KC;Williams, BA;Smith, RB
研究目的：确定意外入院和再入院率，并描述相关原因和费用。设计：回顾性病历数据库分析。设置：大学教学医院。患者：任何在12个月期间接受当天手术（SDS）的患者。测量：所有非选择性在30天内返回医院，并确定返回原因。主要结果：1999年共有20，817例患者接受SDS，其中1，195例（5.7%）在30天内返回医院或在手术后直接入院。在这些非预期的入院和再入院中，313例（1.5%）与原始SDS程序直接相关。这些患者的平均年龄为51岁，164例（52%）为女性，266例（85%）为白人。疼痛是最常报告的返回原因;发生在120例（38%）非预期入院或再入院的患者中。在控制SDS量后，普外科、服务科的发生率最高。意外入院或再次入院的患者占3.2%，其次是耳鼻喉科（3.1%）和泌尿外科（2.9%）。在因疼痛而非预期入院和再入院的120例患者中，46例（38%）在其指数SDS期间接受了骨科手术。非预期入院和因疼痛再次入院患者的平均费用为每次就诊1，869 +/-4，553美元，而非疼痛相关再次入院的费用为12，000 +/-36，886美元。在我们的教学机构，约1.5%的门诊手术患者在30天内因与原始手术程序直接相关的问题而返回。疼痛占回访的三分之一以上，产生了巨大的成本。管理疼痛的努力不仅应集中在医院的疼痛，而且还应预测出院时的疼痛相关问题。(C)2002年，Elsevier Science Inc.
Study Objective: To determine the rate of unanticipated admissions and readmissions, and to characterize the associated reasons and costs.Design: Retrospective medical records database analysis.Setting: University teaching hospital.Patients: Any patient undergoing same day surgery (SDS) during a 12-month period.Measurements: All nonelective return visits to the hospital within 30 days and the reasons for return were identified.Main Results: There were a total of 20,817 patients who underwent SDS in 1999, 1,195 (5.7%) of these returned to the hospital within 30 days or were admitted directly after surgery. Of those unanticipated admissions and readmissions, 313 (1.5%) were directly related to the original SDS procedure. The mean age of these patients was 51 years, 164 (52%) were female, and 266 (85%) were Caucasian. Pain was the most commonly reported reason for return; occurring in 120 (38%) patients who had an unanticipated admission or readmission. After controlling for SDS volume, the general surgery, service had the highest rate. of unanticipated admissions or readmissions (3.2%), followed by otolaryngology (3.1%) and urology (2.9%). Of the 120 patients returning with unanticipated admissions and readmissions due to pain, 46 (38%) had orthopedic procedures during their index SDS. Mean charges for patients with unanticipated admissions and readmission due to pain were $1,869 +/- $4,553 per visit, whereas charges for nonpain related readmissions were $12,000 +/- $36,886Conclusion: At our teaching institution, approximately 1.5% of patients undergoing outpatient ambulatory surgery return within 30 days due to problems directly related to the original surgical procedure. Pain accounted for more than one third of return visits, incurring significant costs. Efforts to manage pain should focus not only on pain in the hospital but also anticipation of pain-related issues on discharge. (C) 2002 by Elsevier Science Inc.