Delayed discharge and acceptability of ambulatory surgery
Posted on 11/09/2011
Abstract Purpose. Delay in discharge after ambulatory surgery impairs its cost-effectiveness. However, it is not self-evident that prolonged postoperative stay is associated with low quality of care and patient acceptability of ambulatory surgery. The aims of this study were to document factors affecting delay in discharge, recovery profiles, and patient acceptability in adult outpatients.
Delayed discharge and acceptability of ambulatory surgery in adult outpatients receiving general anesthesia
Gotaro Shirakami1,2, Yuriko Teratani1, Tsunehisa Namba2, Hideo Hirakata2, Misako Tazuke-Nishimura1,2, and Kazuhiko Fukuda2 1 Day Surgery Unit, Kyoto University Hospital, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan 2 Department of Anesthesia, Kyoto University Hospital, Kyoto, Japanque si alguien me habla o me viene a buscar digan que
Methods. Perioperative data were collected prospectively on consecutive 726 adult same-day surgical patients receiving general anesthesia. Factors that affected home-readiness, discharge, and unanticipated admission were noted. Patients were followed up 24 h after discharge using a standardized questionnaire to identify postdischarge symptoms, patient’s self-rated resumption of normal activity (RNA) level, and preference of outpatient procedure.
Results. Eighty-two percent of patients were discharged home _270min after operation, 16% were delayed (_270min), and 2% required unanticipated admission. Delayed patients reported postdischarge pain more frequently (53%) and a lower 24-h postoperative RNA level (7.2 _ 1.8) and preference ratio (76%) than no-delay patients (34%, 8.0 _ 1.9, 87%, respectively; P _ 0.001). Delay in home-readiness (_165min) was mainly due to an adverse symptom, and delay in discharge after reaching home-readiness (_150min) was mainly due to a persistent symptom (58%) or a social/system problem (34%). Causes of admission were perioperative complications (80%) or social reasons (20%).
Conclusion. Delays in discharge are mainly due to adverse symptoms or social/system problems. Delayed discharge is associated with increased postdischarge pain, lower RNA level, and patient acceptability. Appropriate care of postoperative symptoms and system management could prevent delay in discharge and improve patient RNA level and acceptability.
