Abstract
BackgroundAdvances in healthcare delivery have allowed for the increase in the number of ambulatory surgery procedures performed in Canada. Despite these advances, patients return to hospital following discharge. However, the reason for unplanned healthcare use after ambulatory surgery in Canada is not well understood.AimsTo examine unplanned healthcare use, specifically emergency department visit and hospital admissions, in the 3 days after ambulatory surgery in Ontario, Canada.MethodsThis population-based retrospective cohort study was conducted using de-identified administrative databases. Participants were residents in the province of Ontario, Canada; 18 years and older; and underwent common ambulatory surgical procedures between 2014 and 2018. The outcomes included emergency department (ED) visit and hospital admission. Incidence rates were calculated for the total cohort, for each patient characteristic and for surgical category. The odds ratios and 95% confidence intervals were calculated for each outcome using bivariate and multivariate logistic regression.Results484,670 adults underwent select common surgical procedures during the study period. Patients had healthcare use in the first 3 days after surgery, with 14,950 (3.1%) ED visits and 14,236 (2.9%) admissions. The incidence of ED use was highest after tonsillectomy (8.1%), cholecystectomy (4.2%) and appendectomy (4.0%). Incidence of admissions was highest after appendectomy (21%). Acute pain (19.7%) and haemorrhage (14.2%) were the most frequent reasons for an ED visit and “convalescence following surgery” (49.2%) followed by acute pain (6.2%) and haemorrhage (4.5%) were the main reasons for admission.ConclusionsThese findings can assist clinicians in identifying and intervening with patients at risk of healthcare use after ambulatory surgery. Pain management strategies that can be tailored to the patient, and earlier follow-up for some patients may be required. In addition, administrative decision-makers could use the results to estimate the impact of specific ambulatory procedures on hospital resources for planning and allocation of resources.
Highlights
Advances in healthcare delivery have allowed for the increase in the number of ambulatory surgery procedures performed in Canada
Pain management strategies that can be tailored to the patient, and earlier follow-up for some patients may be required
Administrative decision-makers could use the results to estimate the impact of specific ambulatory procedures on hospital resources for planning and allocation of resources
Summary
Advances in healthcare delivery have allowed for the increase in the number of ambulatory surgery procedures performed in Canada. Despite these advances, patients return to hospital following discharge. Surgical procedures that previously required an in-patient post-surgical hospital stay are more frequently being performed as ambulatory surgery (planned for discharge on day of surgery). In Ontario, from 2008 to 2015, the number of ED visits increased by 13.1%, while the population increased by only 6.2% (Health Quality Ontario, 2016). ED use and admissions after hospital discharge are considered a priority outcome in the Health Quality Ontario Quality Improvement Plan and more attention is being focused on strategies to reduce ED visits (Health Quality Ontario, 2015). One of the contributing factors to increased ED use may be related to increasing rates of ambulatory surgery
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