Analysis of reasons for unplanned overnight recovery after same-day surgery_West China Medical Journal

Authors：

XIONG Huan ^1,2 , ZHAO Xiaoyan ^1,2 , JIANG Ruilian ¹ , SONG Yinghan ² , SUN Yiyuan ^1,2 ,  LAI Xiaoqin ^1,2

1. Day Surgery Center, West China Tianfu Hospital, Sichuan University, Chengdu, Sichuan 610299, P. R. China;
2. Day Surgery Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

LAI Xiaoqin, Email: laixiaoqin@wchscu.cn

Keywords：

Day surgery; same-day surgery; unplanned overnight recovery; surgical scheduling; individual enhanced recovery after surgery

DOI：

10.7507/1002-0179.202310127

Video：

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Objective To analyze the causes of unplanned overnight recovery of patients after same-day surgery and put forward countermeasures. Methods The data of same-day surgery patients in the Day Surgery Center of West China Tianfu Hospital of Sichuan University between February 2022 and May 2023 were selected. Patients who recovered overnight were defined as the unplanned overnight recovery group, and patients discharged on the same day after surgery were defined as the normal same-day group. The factors of unplanned overnight recovery after same-day surgery were analyzed. Results A total of 4 259 patients were enrolled, of whom 107 patients had unplanned overnight recovery, 4 152 patients were discharged on the same day after surgery, unplanned overnight recovery group accounted for 2.51% (107/4 259). Except for gender and age (P>0.05), there were significant differences between the two groups in the following six aspects: late starting time of surgery, longer distance from home, medical insurance settlement restrictions, pain, postoperative complications, and patient’s own factors (P<0.05). The results of logistic regression analysis showed that the late starting time of surgery [odds ratio (OR)=9.386, 95% confidence interval (CI) (2.993, 29.432), P<0.001], long distance from address [OR=4.828, 95%CI (2.015, 11.568), P<0.001], medical insurance settlement restrictions [OR=10.667, 95%CI (3.712, 30.658), P<0.001], pain [OR=30.514, 95%CI (7.688, 121.115), P<0.001], postoperative complications [OR=9.642, 95%CI (2.425, 38.342), P=0.001], and patient’s own factors [OR=16.087, 95%CI (10.358, 24.985), P<0.001] were risk factors for unplanned overnight recovery in same-day surgery patients. Conclusions The unplanned overnight recovery of same-day surgery patients in West China Tianfu Hospital of Sichuan University is related to six factors: late starting time of surgery, long distance from home, medical insurance settlement restrictions, pain, postoperative complications, and patient’s own factors. Medical staff can take corresponding measures to reduce the unplanned overnight recovery rate of same-day surgery by strict access standards, optimizing surgical scheduling, formulating individualized enhanced recovery after surgery programs, improving support for patient after discharge, and strengthening perioperative health education.

Citation： XIONG Huan, ZHAO Xiaoyan, JIANG Ruilian, SONG Yinghan, SUN Yiyuan, LAI Xiaoqin. Analysis of reasons for unplanned overnight recovery after same-day surgery. West China Medical Journal, 2024, 39(2): 178-183. doi: 10.7507/1002-0179.202310127 Copy

1.	安燚, 王振軍. 日間手術的概念和基本問題. 中國實用外科雜志, 2007(1): 38-40.
2.	于麗華. 中國日間手術發展的歷程與展望. 中國醫院管理, 2016, 36(6): 16-18.
3.	雷甜甜, 梁鵬, 馬洪升, 等. 四川大學華西醫院日歸手術管理實踐. 廣東醫學, 2022, 43(10): 1222-1228.
4.	Duignan M, Lao C, Lawrenson R, et al. A policy of day-case sinonasal surgery is safe, well tolerated and cost-effective. J Laryngol Otol, 2021, 135(4): 341-343.
5.	Mayo BC, Massel DH, Bohl DD, et al. Effect of surgery start time on day of discharge in anterior cervical discectomy and fusion patients. Spine (Phila Pa 1976), 2016, 41(24): 1939-1944.
6.	Ganesan S, Prior AJ, Rubin JS. Unexpected overnight admissions following day-case surgery: an analysis of a dedicated ENT day care unit. Ann R Coll Surg Engl, 2000, 82(5): 327-330.
7.	Rutledge J, Siegel E, Belcher R, et al. Barriers to same-day discharge of patients undergoing total and completion thyroidectomy. Otolaryngol Head Neck Surg, 2014, 150(5): 770-774.
8.	Sultan J, Marflow KZ, Roy B. Unplanned overnight admissions in day-case arthroscopic shoulder surgery. Surgeon, 2012, 10(1): 16-19.
9.	Solodkyy A, Hakeem AR, Oswald N, et al. ‘True day case’ laparoscopic cholecystectomy in a high-volume specialist unit and review of factors contributing to unexpected overnight stay. Minim Invasive Surg, 2018, 2018: 1260358.
10.	Elder M, Steven D, Beasley S, et al. Unplanned overnight hospital admission after strabismus surgery. N Z Med J, 2007, 120(1260): U2681.
11.	Cifarelli CP, McMichael JP, Forman AG, et al. Surgical start time impact on hospital length of stay for elective inpatient procedures. Cureus, 2021, 13(7): e16259.
12.	詹麗莉, 劉洋, 蔣麗莎, 等. 日歸模式在日間手術的臨床應用與探討. 華西醫學, 2022, 37(2): 189-193.
13.	楊紅梅, 林艷, 劉佩珍, 等. 手術室運營管理中手術排程研究進展. 護理學報, 2021, 28(11): 12-15.
14.	包安竹, 白曉霞, 王小麗, 等. 手術智能排程系統的設計及臨床應用. 中華護理雜志, 2018, 53(3): 338-342.
15.	Wilmore DW, Kehlet H. Management of patients in fast track surgery. BMJ, 2001, 322(7284): 473-476.
16.	呂子寧, 劉洋, 梁鵬. 個體化的加速康復外科理念在日歸手術麻醉中的應用. 華西醫學, 2022, 37(2): 262-266.
17.	劉洋, 李志超, 馬洪升. 四川大學華西醫院日間手術患者延遲出院原因分析. 中國循證醫學雜志, 2016, 16(4): 383-386.
18.	馬俊麗, 魏新川. 術后惡心嘔吐病因、機制和治療進展. 實用醫院臨床雜志, 2022, 19(1): 190-193.
19.	馬洪升, 程南生, 朱濤, 等. 華西醫院日間手術快速康復(ERAS)規范. 中國胸心血管外科臨床雜志, 2016, 23(2): 104-106.
20.	陳瀟, 張玉俠, 周海英, 等. 術后惡心嘔吐非藥物管理的最佳證據總結. 中華護理雜志, 2021, 56(11): 1721-1727.
21.	Pujahari AK. Day care vs overnight stay after laparoscopic cholecystectomy even with co-morbidity and a possible second surgery: a patient’s choice. J Clin Diagn Res, 2016, 10(10): PC25-PC27.
22.	門琤, 郭滿, 任靜. 甲狀腺惡性腫瘤日間手術患者出院準備度及延遲出院情況調查. 臨床醫學, 2023, 43(6): 54-56.
23.	張晗, 黃明君, 戴燕. 日間手術延遲出院影響因素分析及應對措施. 中國衛生質量管理, 2022, 29(7): 26-31.
24.	馬洪升, 蔣麗莎, 劉洋, 等. 快速康復外科理念在日間手術中的實踐. 中國普外基礎與臨床雜志, 2015, 22(11): 1384-1385.
25.	戴燕, 張雨晨. 醫院-社區一體化服務模式在日間手術出院患者延續護理中的應用. 中華現代護理雜志, 2018, 24(12): 1369-1371.
26.	賀紅, 庹汪陽, 袁華娣, 等. 肺癌患者日間手術后延遲出院的危險因素研究. 中華急危重癥護理雜志, 2022, 3(3): 203-207.
27.	邱玲, 劉春香, 朱瑋, 等. 泌尿系結石日間手術患者延遲出院的危險因素分析. 中華全科醫學, 2021, 19(8): 1265-1268.
28.	余瓊, 鄧雁, 馮林美. 老年日間手術患者延遲出院的風險預測模型構建. 護理學雜志, 2022, 37(15): 52-55.

1. 安燚, 王振軍. 日間手術的概念和基本問題. 中國實用外科雜志, 2007(1): 38-40.
2. 于麗華. 中國日間手術發展的歷程與展望. 中國醫院管理, 2016, 36(6): 16-18.
3. 雷甜甜, 梁鵬, 馬洪升, 等. 四川大學華西醫院日歸手術管理實踐. 廣東醫學, 2022, 43(10): 1222-1228.
4. Duignan M, Lao C, Lawrenson R, et al. A policy of day-case sinonasal surgery is safe, well tolerated and cost-effective. J Laryngol Otol, 2021, 135(4): 341-343.
5. Mayo BC, Massel DH, Bohl DD, et al. Effect of surgery start time on day of discharge in anterior cervical discectomy and fusion patients. Spine (Phila Pa 1976), 2016, 41(24): 1939-1944.
6. Ganesan S, Prior AJ, Rubin JS. Unexpected overnight admissions following day-case surgery: an analysis of a dedicated ENT day care unit. Ann R Coll Surg Engl, 2000, 82(5): 327-330.
7. Rutledge J, Siegel E, Belcher R, et al. Barriers to same-day discharge of patients undergoing total and completion thyroidectomy. Otolaryngol Head Neck Surg, 2014, 150(5): 770-774.
8. Sultan J, Marflow KZ, Roy B. Unplanned overnight admissions in day-case arthroscopic shoulder surgery. Surgeon, 2012, 10(1): 16-19.
9. Solodkyy A, Hakeem AR, Oswald N, et al. ‘True day case’ laparoscopic cholecystectomy in a high-volume specialist unit and review of factors contributing to unexpected overnight stay. Minim Invasive Surg, 2018, 2018: 1260358.
10. Elder M, Steven D, Beasley S, et al. Unplanned overnight hospital admission after strabismus surgery. N Z Med J, 2007, 120(1260): U2681.
11. Cifarelli CP, McMichael JP, Forman AG, et al. Surgical start time impact on hospital length of stay for elective inpatient procedures. Cureus, 2021, 13(7): e16259.
12. 詹麗莉, 劉洋, 蔣麗莎, 等. 日歸模式在日間手術的臨床應用與探討. 華西醫學, 2022, 37(2): 189-193.
13. 楊紅梅, 林艷, 劉佩珍, 等. 手術室運營管理中手術排程研究進展. 護理學報, 2021, 28(11): 12-15.
14. 包安竹, 白曉霞, 王小麗, 等. 手術智能排程系統的設計及臨床應用. 中華護理雜志, 2018, 53(3): 338-342.
15. Wilmore DW, Kehlet H. Management of patients in fast track surgery. BMJ, 2001, 322(7284): 473-476.
16. 呂子寧, 劉洋, 梁鵬. 個體化的加速康復外科理念在日歸手術麻醉中的應用. 華西醫學, 2022, 37(2): 262-266.
17. 劉洋, 李志超, 馬洪升. 四川大學華西醫院日間手術患者延遲出院原因分析. 中國循證醫學雜志, 2016, 16(4): 383-386.
18. 馬俊麗, 魏新川. 術后惡心嘔吐病因、機制和治療進展. 實用醫院臨床雜志, 2022, 19(1): 190-193.
19. 馬洪升, 程南生, 朱濤, 等. 華西醫院日間手術快速康復(ERAS)規范. 中國胸心血管外科臨床雜志, 2016, 23(2): 104-106.
20. 陳瀟, 張玉俠, 周海英, 等. 術后惡心嘔吐非藥物管理的最佳證據總結. 中華護理雜志, 2021, 56(11): 1721-1727.
21. Pujahari AK. Day care vs overnight stay after laparoscopic cholecystectomy even with co-morbidity and a possible second surgery: a patient’s choice. J Clin Diagn Res, 2016, 10(10): PC25-PC27.
22. 門琤, 郭滿, 任靜. 甲狀腺惡性腫瘤日間手術患者出院準備度及延遲出院情況調查. 臨床醫學, 2023, 43(6): 54-56.
23. 張晗, 黃明君, 戴燕. 日間手術延遲出院影響因素分析及應對措施. 中國衛生質量管理, 2022, 29(7): 26-31.
24. 馬洪升, 蔣麗莎, 劉洋, 等. 快速康復外科理念在日間手術中的實踐. 中國普外基礎與臨床雜志, 2015, 22(11): 1384-1385.
25. 戴燕, 張雨晨. 醫院-社區一體化服務模式在日間手術出院患者延續護理中的應用. 中華現代護理雜志, 2018, 24(12): 1369-1371.
26. 賀紅, 庹汪陽, 袁華娣, 等. 肺癌患者日間手術后延遲出院的危險因素研究. 中華急危重癥護理雜志, 2022, 3(3): 203-207.
27. 邱玲, 劉春香, 朱瑋, 等. 泌尿系結石日間手術患者延遲出院的危險因素分析. 中華全科醫學, 2021, 19(8): 1265-1268.
28. 余瓊, 鄧雁, 馮林美. 老年日間手術患者延遲出院的風險預測模型構建. 護理學雜志, 2022, 37(15): 52-55.

West China Medical Journal

Analysis of reasons for unplanned overnight recovery after same-day surgery

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