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October 16-20, 2010 San Diego, CA Home Abstract Archive Search Abstracts 2010 Session Grid 2010 Meeting Website Policy Statements ASA Website Feedback 
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A-38
2002 |
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| A Novel Index of Elevated Risk for Hospital Admission or Death Immediately Following Outpatient Surgery | ||||||||||||
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Lee A. Fleisher, M.D.; Reuven Pasternak, M.D., M.B.A.; Alan Lyles. Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, Maryland |
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Introduction: There is currently very little empiric evidence for the magnitude or for the risk factors for inpatient hospital admissions following ambulatory surgery. Methods: We analyzed data from New York State on outpatient surgery from 1997 which has been submitted to the Hospital Cost and Utilization Project (HCUP) and available through the Agency for Healthcare Research and Quality. Outcomes of interest include death in the outpatient setting or hospital admission. Variables in the dataset include age, gender, procedure, OR time, type of anesthesia, and co-morbidity assessed by the presence of ICD-9CM codes. Results: A total of 783,483 procedures were included in the dataset, 4,351 of which (1 in 180) resulted in discharge directly to short-term hospitalization, and 19 resulted in death (1 in 41,235). Virtually all of the procedures were performed in hospital base units (744,356) as compared to free-standing ambulatory surgery centers (39,202). Independent predictors of hospitalizations and deaths included age > 85, operating room duration 60-119 minutes, operating room duration > 120 minutes, cardiac disease, peripheral vascular disease, cerebrovascular disease, malignancy, HIV positive and general anesthesia. Assigning one point to each for these factors a greater total score is associated with increased risk (Table). Discussion: Using an administrative dataset, we identified nine risk factors associated with an increased rate of hospitalizations/deaths from outpatient surgery and developed a simple index to predict adverse outcome in this setting. The relationship between discharge status and OR time and type of anesthesia most likely reflects surgical complexity, but requires further review. After further validation, we propose that this index could be utilized to identify patients who might benefit from outpatient surgery in units for which expeditious admission and emergency treatment is facilitated. Anesthesiology 2002; 96: A38 |
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