Most unanticipated admissions following ambulatory surgery in children are related to anesthesia, with otolaryngology procedures and obstructive sleep apnea (OSA) among the most significant predictive factors for admission.
These are the findings of a case control study in which Canadian researchers retrospectively reviewed more than 21,000 pediatric patients who underwent ambulatory surgery in a single center to evaluate the incidence of unanticipated admission and risk factors.
The study found that the incidence of unanticipated admission is low but significant for children following ambulatory surgery. Among 21,957 study patients, unanticipated admissions occurred in 213 (0.97%).
For children who require admission, the study found that anesthesia-related causes accounted for most (46%) of these admissions. Postoperative hypoxia, inadequate pain control, and postoperative nausea and vomiting were the most frequent causes of anesthesia-related admission (occurring in 33%, 23%, and 20% of children, respectively).
Along with otolaryngology procedures and OSA, other risk factors found on multivariate analysis to be predictors for unanticipated admissions are:
- Age younger than 2 years;
- ASA class 3;
- Surgery lasting longer than one hour;
- Completion of surgery later than 3:00 pm,
- Type of surgery (dental and orthopedic); and
- Intraoperative events.
According to the study authors, the prevalence of anesthesia-related causes in their study “appears to be airway-related as postoperative hypoxia is listed as the most common cause and both OSA and intraoperative events (the most common being laryngospasm) are predictive of admission.”
The prevalence of anesthesia-related causes is an exceptional finding in their study, say the authors, as previous data show that surgery is the most common reason for unanticipated admission for both children and adults. The authors hope these findings will help identify children at risk for unanticipated admissions after ambulatory surgery.