Causas de ingresos no deseados tras la realización de procedimientos quirúrgicos de cirugía ortopédica y traumatología en cirugía mayor ambulatoria / Causes of unplanned admission after orthopedic procedures in ambulatory surgery

OBJETIVO: Los procedimientos de cirugía ortopédica y traumatología realizados en unidades de cirugía mayor ambulatoria ofrecen importantes ventajas que desaparecen cuando la recuperación postoperatoria no es la esperada y los pacientes precisan ingresar. El objetivo de este estudio es analizar las causas de ingresos no deseados tras intervenciones quirúrgicas de cirugía ortopédica y traumatología en una unidad de cirugía mayor ambulatoria en relación con variables como edad, riesgo anestésico, tipo de anestesia, procedimiento o duración. MÉTODOS: Estudio de cohorte ambispectivo sobre 5.085 pacientes intervenidos desde 1995 a 2017. Se analizaron 39 variables proporcionadas por la base de datos de la unidad que se abre al ingreso en la misma y se cierra el día 30 postoperatorio. RESULTADOS: El 98,2% de los pacientes fueron dados de alta de la unidad. Precisaron ingresar 74 (1,5%). Este porcentaje demostró diferencias significativas en relación con el tipo de procedimiento, el tipo de anestesia y la duración, que condicionaron el ingreso inmediato por mal control del dolor agudo postoperatorio, náuseas o alteraciones de la herida. Diecisiete pacientes (0,3%) precisaron un ingreso diferido por complicaciones surgidas en el domicilio, siendo la más frecuente la infección de la herida. CONCLUSIONES: Los ingresos no deseados se relacionan con mayor frecuencia con el empleo de anestesia general, con operaciones de mayor duración y con procedimientos como la cirugía artroscópica, las correcciones de hallux valgus o las retiradas de material de osteosíntesis, siendo las causas de ingreso más importantes el mal control del dolor agudo postoperatorio en los inmediatos y la infección de la herida en los diferidos

OBJECTIVE: Orthopaedic procedures performed in Day Surgery Units provide important advantages which disappear when patients require admission when postoperative recovery is not as expected. The aim of this study was to analyse the reasons for unplanned hospital admissions after orthopaedic procedures in a Day Surgery Unit and their relationship between variables such as patient age, anaesthetic risk and technique, procedure or duration. METHODS: Ambispective cohort study of 5,085 patients who underwent surgical orthopaedic procedures between 1995 and 2017. Thirty-nine variables provided by the Unit's database were analysed. The database was opened on the day of admission and closed the 30th postoperative day. RESULTS: Of the patients, 98.2% were discharged from the Unit. Seventy-four (1.5%) required overnight admission. This percentage showed significant differences in relation to the type of procedure, type of anaesthesia and duration, which conditioned overnight admission due to inadequate postoperative pain management, nausea or wound complications. Seventeen patients (0.3%) required readmission after discharge due to complications that arose at home, such as wound infection, which was the most common. CONCLUSIONS: Unplanned admissions are more frequently related to general anaesthesia, lengthy surgeries and procedures such as arthroscopy, hallux valgus corrections or removal of osteosynthesis material. The major reasons for unplanned admissions were inadequate postoperative pain management for overnight admissions and wound infection for admissions after discharge

Causes of unplanned admission after orthopedic procedures in ambulatory surgery. / Causas de ingresos no deseados tras la realización de procedimientos quirúrgicos de cirugía ortopédica y traumatología en cirugía mayor ambulatoria.

OBJECTIVE: Orthopaedic procedures performed in Day Surgery Units provide important advantages which disappear when patients require admission when postoperative recovery is not as expected. The aim of this study was to analyse the reasons for unplanned hospital admissions after orthopaedic procedures in a Day Surgery Unit and their relationship between variables such as patient age, anaesthetic risk and technique, procedure or duration. METHODS: Ambispective cohort study of 5,085 patients who underwent surgical orthopaedic procedures between 1995 and 2017. Thirty-nine variables provided by the Unit's database were analysed. The database was opened on the day of admission and closed the 30th postoperative day. RESULTS: Of the patients, 98.2% were discharged from the Unit. Seventy-four (1.5%) required overnight admission. This percentage showed significant differences in relation to the type of procedure, type of anaesthesia and duration, which conditioned overnight admission due to inadequate postoperative pain management, nausea or wound complications. Seventeen patients (0.3%) required readmission after discharge due to complications that arose at home, such as wound infection, which was the most common. CONCLUSIONS: Unplanned admissions are more frequently related to general anaesthesia, lengthy surgeries and procedures such as arthroscopy, hallux valgus corrections or removal of osteosynthesis material. The major reasons for unplanned admissions were inadequate postoperative pain management for overnight admissions and wound infection for admissions after discharge.

Estudio transversal de las complicaciones postoperatorias detectadas mediante contacto telefónico en pacientes intervenidos en una Unidad de Cirugía Mayor Ambulatoria / Transversal study of postoperative complications through phone contact with patients operated on day surgery

Introducción: Algunas publicaciones establecen el control ineficaz del dolor agudo postoperatorio como uno de los principales problemas en las unidades de Cirugía Mayor Ambulatoria. El objetivo principal del estudio ha sido conocer las complicaciones postoperatorias más frecuentes en la unidad y las intervenciones que más frecuentemente las producen. Metodología: Estudio observacional, descriptivo, transversal, realizado a través del análisis de 12.850 llamadas telefónicas, desde marzo de 1999 hasta marzo de 2015. Como instrumento de medida se empleó un cuestionario no validado, diseñado específicamente para ese propósito. Para el análisis de los datos se utilizó el programa Stat View 5.0.1. El nivel de confianza del estudio se estableció en p < 0,05. Resultados: Como complicaciones más destacadas, el 10,56 % de los pacientes manifestó dolor, el 8,54 % detectó el apósito manchado y el 2,63 % sintió náuseas. Los pacientes intervenidos sobre patología ósea fueron los que más dolor expresaron (40,06 %); los operados de otorrinolaringología (excepto oído), los que más manifestaron haber manchado el apósito (33,71 %) y los pacientes intervenidos de cirugía general, los que más náuseas refirieron (14,10 %), todos ellos con una diferencia estadísticamente significativa (p < 0,0001). Conclusiones: El mal control del dolor agudo postoperatorio se constituye como la incidencia postoperatoria más relevante en el domicilio, muy especialmente tras las intervenciones sobre patología ósea (AU)

Background: Inefficient control of Acute Postoperative Pain has been stablished as one of the main problems in Day Surgery Units in recent published works. The primary endpoint of this study was to identify the most frequent postoperative complaints in the Day Surgery Unit and its relationship with different surgical procedures. Methods: Between March 1999 and March 2015, 12,850 phone calls were enrolled in an observational, descriptive transversal trial. A non-validated questionnaire, specifically designed, was used as a measurement tool. Data were analysed by Stat View 5.0.1 software. P values less than 0.05 were considered statistically significant. Results: Among the most important complications, 10.56 % of patients reported bad postoperative pain control, 8.54 % detected stained dressing and 2.63 % suffered nausea. With a statistically significant difference (p < 0,0001), patients operated on bone pathology (mainly hallux valgus correction) were those who expressed more pain (40.06 %), patients operated on ENT procedures (excluding ear) were those who reported more stained dressing (33.71 %) and patients operated on General Surgery procedures were those who suffered more postoperative nausea (14.10 %). Conclusions: Bad postoperative acute pain control becomes the most relevant complaint at home, mainly after bone pathology correction (AU)