Unplanned admissions after day-case surgery in an Italian third-level pediatric hospital: a retrospective study

Alessandro Vittori; Luigi Tritapepe; Fabrizio Chiusolo; Emanuele Rossetti; Marco Cascella; Emiliano Petrucci; Roberto Pedone; Franco Marinangeli; Elisa Francia; Ilaria Mascilini; Giuliano Marchetti; Sergio Giuseppe Picardo

doi:10.1186/s13741-023-00342-y

Unplanned admissions after day-case surgery in an Italian third-level pediatric hospital: a retrospective study

Perioper Med (Lond). 2023 Sep 26;12(1):53. doi: 10.1186/s13741-023-00342-y.

Authors

Affiliations

¹ Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy. alexvittori82@gmail.com.
² Department of Anesthesiology, Critical Care, and Pain Medicine, San Camillo Forlanini Hospital, Circonvallazione Gianicolense 87, 00152, Rome, Italy.
³ Unit of Anesthesia and Intensive Care, Sapienza University, Piazzale Aldro Moro 5 00185, Rome, Italy.
⁴ Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.
⁵ Department of Anesthesia and Critical Care, Istituto Nazionale Tumori-IRCCS, Fondazione Pascale, Via Mariano Semmola, 53, 80131, Naples, Italy.
⁶ Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L'Aquila, Via Lorenzo Natali, 1, 67100, Coppito, L'Aquila, Italy.
⁷ Department of Psychology, University of Campania Luigi Vanvitelli, Viale Abramo Lincoln, 5, 81100, Caserta, Italy.
⁸ Department of Anesthesiology, Intensive Care and Pain Treatment, University of L'Aquila, , L'Aquila, Piazzale Salvatore Tommasi, 1, 67100, Coppito, AQ, Italy.
⁹ Surgery Unit, Bios Medical Center, Via Domenico Chelini, 39, 00197, Rome, Italy.

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.

Keywords: Ambulatory anesthesia; Children; Day-case surgery; Pain; Pediatric anesthesia; Unplanned admission.