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Shah S, Qureshi F, Stanley S, Bennett-Guerrero E. Unplanned hospital admissions within 24 h after 53,185 surgical procedures at a U.S. ambulatory surgery center. Perioper Med (Lond) 2024; 13:88. [PMID: 39138487 DOI: 10.1186/s13741-024-00447-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: 04/16/2024] [Accepted: 08/05/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Unplanned admission after surgery at an ambulatory surgery center (ASC) is an established measure of the quality of care and can affect the patient's experience. Previous studies on this topic are generally dated, focused on a single specialty, or studied 30-day admissions after ambulatory surgery. Few studies have reported admission within 24 h after surgery at an ASC which is a different but important measure of the quality of anesthetic and surgical care. Understanding admissions within 24 h of surgery can identify opportunities for improvement immediately after surgery. Therefore, our study was designed to assess the incidence and risk factors for unplanned hospital admissions within 24 h after surgery performed at a hospital ASC. METHODS After Institutional Review Board approval, a retrospective analysis was performed on all adult patients who underwent surgery at a US ASC between January 1, 2016, and December 31, 2022. Data were obtained from the hospital's electronic medical record. The study sample was divided into two groups: those with an unplanned hospital admission within 24 h after surgery and those without an unplanned hospital admission. To evaluate risk factors for unplanned hospital admissions, univariate analyses with p value < 0.05 were utilized to identify significant patient variables related to hospital admissions. These variables were further adjusted using a multivariable Firth logistic regression. Descriptive statistics were used to explore the number of patients in different variable categories. RESULTS Overall, 53,185 cases were identified for the 7-year period. The incidence of unplanned hospital admission over this period was 0.09% (95% CI 0.07-0.1122%; ranging from 0.05 to 0.12% per year. In the multivariable model, surgery duration (OR 1.010, 95% CI 1.007-1.012, p value < 0.0001), peripheral vascular disease (OR 14.489, 95% CI 4.862-43.174, p value < 0.0001), and deep venous thrombosis (OR 5.527, 95% CI 1.909-16.001, p value = 0.0016) were significantly associated with unplanned hospital admission. CONCLUSION The overall incidence of unplanned hospital admission after surgery at a large tertiary care ambulatory surgery center is very low. This admission rate can also serve as a reference point for future studies and quality improvement initiatives.
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Affiliation(s)
- Syed Shah
- Department of Anesthesiology, Stony Brook University Medical Center, Stony Brook, USA
| | - Faiza Qureshi
- Patient Care Services, Stony Brook Eastern Long Island Hospital, Stony Brook, USA.
| | - Samuel Stanley
- Department of Anesthesiology, Stony Brook University Medical Center, Stony Brook, USA
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Ross JH, Abrams M, Vasavada SP, Mangel JM, Ferrando CA. Does the setting for intradetrusor onabotulinumtoxinA injection for management of overactive bladder matter? Indian J Urol 2024; 40:101-106. [PMID: 38725899 PMCID: PMC11078453 DOI: 10.4103/iju.iju_228_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 05/12/2024] Open
Abstract
Introduction Intradetrusor onabotulinumtoxinA (Botox) injections, to treat idiopathic overactive bladder (OAB), can be performed in the office setting under local analgesia alone or in the operating room (OR) under local and/or sedation. The objective of this study was to compare the symptomatic improvement in patients with OAB who underwent treatment with intradetrusor onabotulinumtoxinA injections in an in-office versus the OR setting. Methods We performed a multicenter retrospective cohort study of women with the diagnosis of refractory non-neurogenic OAB who elected to undergo treatment with intradetrusor onabotulinumtoxinA injections between January 2015 and December 2020. The electronic medical records were queried for all the demographic and peri-procedural data, including the report of subjective improvement post procedure. Patients were categorized as either "in-office" versus "OR" based on the setting in which they underwent their procedure. Results Five hundred and thirty-nine patients met the inclusion criteria: 297 (55%) in the in-office group and 242 (45%) in the OR group. A total of 30 (5.6%) patients reported retention after their procedure and it was more common in the in-office group (8.1%) versus the OR group (2.5%), (P = 0.003). The rate of urinary tract infection within 6 months of the procedure was higher in the OR group (26.0% vs. 16.8%, P = 0.009). The overall subjective improvement rate was 77% (95% confidence interval: 73%-80%). Patients in the OR group had a higher reported improvement as compared to the in-office group (81.4% vs. 73.3%, P = 0.03). Conclusions In this cohort study of patients with OAB undergoing intradetrusor onabotulinumtoxinA injections, post procedural subjective improvement was high regardless of the setting in which the procedure was performed.
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Affiliation(s)
- James H. Ross
- Center for Urogynecology and Pelvic Reconstructive Surgery, Cleveland Clinic, Obstetrics, Gynecology and Women’s Health Institute, Cleveland, Ohio
| | - Megan Abrams
- Division of Female Pelvic Medicine and Reconstructive Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Sandip P. Vasavada
- Cleveland Clinic Foundation, Glickman Urological Institute, Cleveland, Ohio
| | - Jeffrey M. Mangel
- Division of Female Pelvic Medicine and Reconstructive Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Cecile A. Ferrando
- Center for Urogynecology and Pelvic Reconstructive Surgery, Cleveland Clinic, Obstetrics, Gynecology and Women’s Health Institute, Cleveland, Ohio
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Young S, Osman B, Shapiro FE. Safety considerations with the current ambulatory trends: more complicated procedures and more complicated patients. Korean J Anesthesiol 2023; 76:400-412. [PMID: 36912006 PMCID: PMC10562071 DOI: 10.4097/kja.23078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023] Open
Abstract
In the last quarter of a century, the backdrop of appropriate ambulatory and office-based surgeries has changed dramatically. Procedures that were traditionally done in hospitals or patients being admitted after surgery are migrating to the outpatient setting and being discharged on the same day, respectively, at a remarkable rate. In the face of this exponential growth, anesthesiologists are constantly being challenged to maintain patient safety by understanding the appropriate patient selection, procedure, and surgical location. Recently published literature supports the trend of higher, more medically complex patients, and more complicated procedures shifting towards the outpatient arena. Several reasons that may account for this include cost incentives, advancement in anesthesia techniques, enhanced recovery after surgery (ERAS) protocols, and increased patient satisfaction. Anesthesiologists must understand that there is a lack of standardized state regulations regarding ambulatory surgery centers (ASCs) and office-based surgery (OBS) centers. Current and recently graduated anesthesiologists should be aware of the safety concerns related to the various non-hospital-based locations, the sustained growth and demand for anesthesia in the office, and the expansion of mobile anesthesia practices in the US in order to keep up and practice safely with the professional trends. Continuing procedural ambulatory shifts will require ongoing outcomes research, likely prospective in nature, on these novel outpatient procedures, in order to develop risk stratification and prediction models for the selection of the proper patient, procedure, and surgery location.
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Affiliation(s)
- Steven Young
- Department of Anesthesiology, 1Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Brian Osman
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Fred E. Shapiro
- Department of Anesthesiology, 1Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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Clouet R, Dajean-Trutaud S, Grall-Bronnec M, Bray E, Victorri-Vigneau C, Prud'homme T. Objectivation of the Equimolar Mixture of Oxygen and Nitrous Oxide Anxiolytic Effect in Pediatric Dentistry: A Pilot Study. Int J Clin Pediatr Dent 2023; 16:270-275. [PMID: 37519986 PMCID: PMC10373781 DOI: 10.5005/jp-journals-10005-2540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
Aim EMONO is an equimolar mixture of oxygen and nitrous oxide. Studies investigating its anxiolytic effect mostly used behavioral scales for assessing anxiolysis in children during dental care. Observing this effect objectively in a pediatric population could be very interesting. Materials and methods We conducted a prospective uncontrolled monocentric pilot study to assess the equimolar mixture of oxygen and nitrous oxide (EMONO) anxiolytic effect in children during dental care by monitoring heart rate (HR) variation. Results A statistically significant difference could be highlighted between the HR before the dental care and after 5 minutes of EMONO inhalation, illustrating the anxiolytic effect of EMONO in an objective way. HR variation also suggests that the effect of EMONO seems to prevent a return to the initial level of stress, even during anesthesia. Conclusion All of the data in the literature confirm the essential role of nitrous oxide in pediatric dental care. Demonstrating the effectiveness of EMONO by objective criteria is necessary. Trial registration Clinical Trials Unique Protocol ID: RC17_0275. How to cite this article Clouet R, Dajean-Trutaud S, Grall-Bronnec M, et al. Objectivation of the Equimolar Mixture of Oxygen and Nitrous Oxide Anxiolytic Effect in Pediatric Dentistry: A Pilot Study. Int J Clin Pediatr Dent 2023;16(2):270-275.
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Affiliation(s)
- Roselyne Clouet
- Department of Periodontology, Nantes Université, CHU Nantes, Service d’Odontologie, Nantes, France
| | - Sylvie Dajean-Trutaud
- Department of Periodontology, Nantes Université, CHU Nantes, Service d’Odontologie, Nantes, France
| | - Marie Grall-Bronnec
- Department of Periodontology, Nantes Université, CHU Nantes, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, Nantes, France
| | - Estelle Bray
- Department of Periodontology, Nantes Université, CHU Nantes, Service d’Odontologie, Nantes, France
| | - Caroline Victorri-Vigneau
- Department of Periodontology, Nantes Université, CHU Nantes, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, Nantes, France
| | - Tony Prud'homme
- Department of Periodontology, Nantes Université, CHU Nantes, Service d’Odontologie, Nantes, France
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Khusid JA, Hordines JC, Sadiq AS, Atallah WM, Gupta M. Prevention and Management of Infectious Complications of Retrograde Intrarenal Surgery. Front Surg 2021; 8:718583. [PMID: 34434958 PMCID: PMC8381273 DOI: 10.3389/fsurg.2021.718583] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/14/2021] [Indexed: 01/11/2023] Open
Abstract
Kidney stone disease (KSD) is a commonly encountered ailment in urologic practice. Urinary tract infection (UTI) is commonly associated with KSD, both as an etiology (e.g., struvite and carbonate apatite stones), and as a complication (i.e., obstructive pyelonephritis and post-operative UTI). Indeed, a significant portion of the economic burden of KSD is skewed toward stones associated with infection. UTI is the most common post-operative complication related to stone intervention with progression to urosepsis as a rare but serious consequence. Risk for infection is influenced by a variety of factors including co-morbid conditions, anatomic abnormalities, prior surgical procedures, and local anti-microbial susceptibility. Understanding these risks and the proper steps to mitigate them is an essential component in reducing post-operative morbidity and mortality. Retrograde intrarenal surgery is routinely used for the treatment of KSD. The objective of this review article is to examine the current literature and guidelines for the prevention and management of stone-related infectious complications associated with retrograde intrarenal surgery. Special attention will be given to the incidence, etiology, and antibiotic prophylaxis choice in the management of stone-related infections. Intraoperative risk mitigation techniques will be discussed in conjunction with the management of post-operative infections. Antibiotic stewardship and the potential benefits of reduced empiric antibiotic treatment will also be discussed.
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Affiliation(s)
- Johnathan A Khusid
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - John C Hordines
- Department of Urology, SUNY Downstate College of Medicine, Brooklyn, NY, United States
| | - Areeba S Sadiq
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - William M Atallah
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Mantu Gupta
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Use of Nitrous Oxide in Office-based Urologic Procedures: A Review. Urology 2020; 143:33-41. [PMID: 32445762 DOI: 10.1016/j.urology.2020.05.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/20/2020] [Accepted: 05/10/2020] [Indexed: 12/22/2022]
Abstract
Nitrous oxide (N2O) is underutilized in ambulatory urology. Here, we review available data regarding application, efficacy, and side effect profile of N2O in ambulatory urologic procedures. Data were available from 11 studies. N2O has been described in the setting of transrectal ultrasound-guided prostate biopsies, flexible cystoscopy, ureteral stent placement, and extracorporeal shockwave lithotripsy in adult patients and catheterization in children. Studies showed significant improvements in peri-procedural pain and anxiety relative to alternative (or none) forms of analgesia. Adverse effects were rare and self-limited. More widespread use of N2O may result in cost savings and better patient tolerance with outpatient procedures.
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