1
|
Vittori A, Tritapepe L, Chiusolo F, Rossetti E, Cascella M, Petrucci E, Pedone R, Marinangeli F, Francia E, Mascilini I, Marchetti G, Picardo SG. Unplanned admissions after day-case surgery in an Italian third-level pediatric hospital: a retrospective study. Perioper Med (Lond) 2023; 12:53. [PMID: 37752610 PMCID: PMC10523757 DOI: 10.1186/s13741-023-00342-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 09/21/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Increasing procedures in day-case surgery can mitigate the costs of health service, without reducing safety and quality standards. The Ospedale Pediatrico Bambino Gesù has adopted an educational program for healthcare personnel and patients' families to increase the number of day-case surgery procedures performed without reducing the level of safety. The unplanned admission rate after day-case surgery can be a quality benchmark for pediatric day-case surgery, and in literature, there are no Italian data. METHODS We made a retrospective analysis of the hospital database and focused on children requiring unplanned admission to the central venue of the hospital for the night. The audit covered the period from September 2012 to April 2018. RESULTS We performed general anesthesia for 8826 procedures (urology 33.60%, plastic surgery 30.87%, general surgery 17.44%, dermatology 11.66%, dentistry 3.16%, orthopedics 1.64%, digestive endoscopy 1.63%). Unplanned admission for anesthetic reasons resulted in two cases: one case of syncope and one case of vomit (0.023% rate). No one major complication. CONCLUSIONS Good quality of patient selection, the safety of the structure, family education, and an efficient organizational model combined with an educational program for anesthesiologists can improve the safety of anesthesia for day-case surgery.
Collapse
Affiliation(s)
- Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.
| | - Luigi Tritapepe
- Department of Anesthesiology, Critical Care, and Pain Medicine, San Camillo Forlanini Hospital, Circonvallazione Gianicolense 87, 00152, Rome, Italy
- Unit of Anesthesia and Intensive Care, Sapienza University, Piazzale Aldro Moro 5 00185, Rome, Italy
| | - Fabrizio Chiusolo
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Emanuele Rossetti
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Marco Cascella
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori-IRCCS, Fondazione Pascale, Via Mariano Semmola, 53, 80131, Naples, Italy
| | - Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L'Aquila, Via Lorenzo Natali, 1, 67100, Coppito, L'Aquila, Italy
| | - Roberto Pedone
- Department of Psychology, University of Campania Luigi Vanvitelli, Viale Abramo Lincoln, 5, 81100, Caserta, Italy
| | - Franco Marinangeli
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L'Aquila, , L'Aquila, Piazzale Salvatore Tommasi, 1, 67100, Coppito, AQ, Italy
| | - Elisa Francia
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Ilaria Mascilini
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Giuliano Marchetti
- Surgery Unit, Bios Medical Center, Via Domenico Chelini, 39, 00197, Rome, Italy
| | - Sergio Giuseppe Picardo
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| |
Collapse
|
2
|
Taylor KL, Frndova H, Szadkowski L, Joffe AR, Parshuram CS. Risk factors for unplanned paediatric intensive care unit admission after anaesthesia—an international multicentre study. Paediatr Child Health 2022; 27:333-339. [DOI: 10.1093/pch/pxac041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
Unplanned intensive care unit (ICU) admissions are associated with near-miss events, morbidity, and mortality. We describe the rate, resource utilization, and outcomes of paediatric patients urgently admitted directly to ICU post-anaesthesia compared to other sources of unplanned ICU admissions.
Methods
We performed a secondary analysis of data from specialist paediatric hospitals in 7 countries. Patients urgently admitted to the ICU post-anaesthesia were combined and matched with 1 to 3 unique controls from unplanned ICU admissions from other locations by age and hospital. Demographic, clinical, and outcome variables were compared using the Wilcoxon rank-sum test for continuous variables and chi-square or Fisher’s exact test for categorical variables. The effect of admission sources on binary outcomes was estimated using univariable conditional logistic regression models with stratification by matched set of anaesthesia and non-anaesthesia admission sources.
Results
Most admissions were <1 year of age and for respiratory reasons. Admissions post-anaesthesia were shorter, occurred later in the day, and were more likely to be mechanically ventilated. Admissions post-anaesthesia were less likely to have had a previous ICU admission (4.8% compared to 11%, P=0.032) or PIM ‘high-risk diagnosis’ (9.5% versus 17.2%, P=0.035) but there was no difference in the number of subsequent ICU admissions. There was no difference in the PIM severity of illness score and no mortality difference between the groups.
Conclusions
Young children and respiratory indications dominated unplanned ICU admissions post-anaesthesia, which was more likely later in the day and with mechanical ventilation.
Collapse
Affiliation(s)
- Katherine L Taylor
- Department of Anesthesia and Pain Medicine, Hospital for Sick Children , Toronto, Ontario , Canada
- Department of Anesthesia, University of Toronto , Toronto, Ontario , Canada
| | - Helena Frndova
- Department of Critical Care Medicine, Division of Critical Care Medicine, The Hospital for Sick Children , Toronto, Ontario , Canada
| | - Leah Szadkowski
- University Health Network, University of Toronto , Toronto, Ontario , Canada
| | - Ari R Joffe
- Division of Critical Care Medicine, Department of Pediatrics, University of Alberta , Edmonton, Alberta , Canada
| | - Christopher S Parshuram
- Department of Critical Care Medicine, Division of Critical Care Medicine, The Hospital for Sick Children , Toronto, Ontario , Canada
- Department of Critical Care Medicine, Department of Paediatrics, University of Toronto , Toronto, Ontario , Canada
| |
Collapse
|
3
|
Tsuboi K, Ninagawa J, Tsuboi N, Nakagawa S, Suzuki Y. Unplanned admission to pediatric intensive care after general anesthesia: A seven-year retrospective cohort study in a tertiary children's hospital. Paediatr Anaesth 2022; 32:56-61. [PMID: 34687108 DOI: 10.1111/pan.14313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 10/08/2021] [Accepted: 10/17/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Thorough preoperative risk assessment and planning is key to improving patient safety in the perioperative period. Analysis of unplanned ICU admissions after general anesthesia has been validated as a measure of patient safety and its use as a quality initiative is recommended in many countries. AIMS The aims of this study were to determine the reasons for unplanned ICU admission, required interventions, and outcomes after general anesthesia in our hospital, as well as predictability and preventability of the events that led to admission with a view to improving anesthetic management. METHODS A single-center, retrospective cohort study in a tertiary children's hospital was performed. All patients under the age of 18 years admitted to our PICU between June 2014 and May 2021 were included. Unplanned ICU admission after general anesthesia was defined as an admission to the ICU either immediately postoperatively or after recovery room stay, which was not planned preoperatively. The reasons for ICU admission were classified as anesthesia-related, surgical, medical, or mixed. Required intervention, length of ICU stay, and patient outcome of each group, as well as preventability and predictability of the events were investigated. RESULTS There were 75 admissions, representing 0.23% of all general anesthesia procedures during the study period. "Anesthesia-related" was the major reason for admission of which the majority required observation only or transient respiratory support with a median ICU stay of two days. Most of the admissions for medical reasons required disease-specific interventions resulting in the longest ICU stays with a median of six days. A total of 19% of the admissions were preventable, where most of them were for anesthesia-related reasons, and 33% were predictable. Seven patients required cardiopulmonary resuscitation, of which one patient died, giving an observed mortality rate of 1.3% overall. All but one patient who died demonstrated no changes in the Pediatric Cerebral Performance Category (PCPC) scale. CONCLUSION "Anesthesia-related" was the leading reason for unplanned ICU admissions, of which the majority required only observation or transient respiratory support. All but one patient who died demonstrated no changes in the PCPC scale, presenting favorable outcome overall.
Collapse
Affiliation(s)
- Kaoru Tsuboi
- Department of Critical Care and Anesthesia, National Center for Child Health and Development, Tokyo, Japan
| | - Jun Ninagawa
- Department of Critical Care and Anesthesia, National Center for Child Health and Development, Tokyo, Japan
| | - Norihiko Tsuboi
- Department of Critical Care and Anesthesia, National Center for Child Health and Development, Tokyo, Japan
| | - Satoshi Nakagawa
- Department of Critical Care and Anesthesia, National Center for Child Health and Development, Tokyo, Japan
| | - Yasuyuki Suzuki
- Department of Critical Care and Anesthesia, National Center for Child Health and Development, Tokyo, Japan
| |
Collapse
|
4
|
Landry EK, Gabriel RA, Beutler S, Dutton RP, Urman RD. Analysis of Unplanned Intensive Care Unit Admissions in Postoperative Pediatric Patients. J Intensive Care Med 2016; 32:204-211. [PMID: 27530513 DOI: 10.1177/0885066616661152] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Currently, there are only a few retrospective, single-institution studies that have addressed the prevalence and risk factors associated with unplanned admissions to the pediatric intensive care unit (ICU) after surgery. Based on the limited amount of studies, it appears that airway and respiratory complications put a child at increased risk for unplanned ICU admission. A more extensive and diverse analysis of unplanned postoperative admissions to the ICU is needed to address risk factors that have yet to be revealed by the current literature. AIM To establish a rate of unplanned postoperative ICU admissions in pediatric patients using a large, multi-institution data set and to further characterize the associated risk factors. METHODS Data from the National Anesthesia Clinical Outcomes Registry were analyzed. We recorded the overall risk of unplanned postoperative ICU admission in patients younger than 18 years and performed univariate and multivariate logistic regression analysis to identify the associated patient, surgical, and anesthetic-related characteristics. RESULTS Of the 324 818 cases analyzed, 211 reported an unexpected ICU admission. There was an increased likelihood of unplanned postoperative ICU in infants (age <1 year) and children who were classified as American Society of Anesthesiologists physical status classification of III or IV. Likewise, longer case duration and cases requiring general anesthesia were also associated with unplanned ICU admissions. CONCLUSION This study establishes a rate of unplanned ICU admission following surgery in the heterogeneous pediatric population. This is the first study to utilize such a large data set encompassing a wide range of practice environments to identify risk factors leading to unplanned postoperative ICU admissions. Our study revealed that patient, surgical, and anesthetic complexity each contributed to an increased number of unplanned ICU admissions in the pediatric population.
Collapse
Affiliation(s)
- Elizabeth K Landry
- 1 Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rodney A Gabriel
- 2 Department of Anesthesiology, University of California, San Diego, CA, USA
| | - Sascha Beutler
- 1 Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Richard P Dutton
- 3 Chief Quality Officer, US Anesthesia Partners (USAP), Dallas, TX, USA
| | - Richard D Urman
- 1 Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|