Unanticipated admission after ambulatory surgery in the pediatric population: a single-center retrospective analysis.

Introduction: The incidence of adverse events in day surgery is an important quality indicator. This retrospective study investigated factors independently associated with unanticipated admission of pediatric patients after ambulatory surgery.

Patients And Methods: Ambulatory pediatric patients requiring unanticipated admission between January 2016 and December 2018 were compared to ambulatory pediatric patients who were discharged home after a planned surgery. Demographic data, organizational data, American Society of Anesthesiologists (ASA) classification, type of surgery, type of anesthesia, length of surgery, time of completion of the surgery, campus site, and season were collected in both groups. The reason for unexpected admission was classified according to four subtypes: anesthetic, medical, social/organizational and surgical reason, respectively. Multivariate logistic regression was used to identify independent factors associated with unanticipated admission.

Results: From a total of 4235 pediatric patients, 78 children (1.9%) required unanticipated admission. The reasons for admission were anesthetic  = 29 (37.3%), surgical  = 20 (25.6%), medical  = 16 (20.5%) and social/organizational  = 13 (16.6%). Age <2 years (odds ratio [OR] 3.005, 95% confidence interval (CI) 1.500-6.018; ASA class 2 (OR 2.144; 95% CI 1.193-3.852); ASA class 3 (OR 11.617; CI 5.698-23.685); length of surgery >2 h (OR 3.056; CI 1.829-5.107); completion of surgery > 2:30 PM (OR 3.507; CI 1.854-6.633) and campus site (OR 3.628; CI 1.991-6.610) were factors significantly associated with unanticipated admission.

Conclusion: Children are less likely to be admitted after ambulatory surgery when preoperatively carefully selected and when prioritized considering age, general health condition and invasiveness of the surgery.