Predictive Factors of Admission in Outpatient Laparoscopic Surgery

Abstract

Introduction: The aim of the study is to analyze the rate of no planificated hospitalization after ambulatory surgical procedures by laparoscopy, and identify associated risk factors to failure in the ambulatory manage of this patients.

Methods: A prospective observational study was performed during 18 months and included 297 patients treated with ambulatory laparoscopies performed at University Hospital La Fe of Valencia. The need for hospital admission, same day after surgery, was considered the main variable. Variables were recorded for preoperatives, intraoperatives o postoperatives factors. To identify risk factors and variables associated with complications, statistical analyses were calculated with logistic regression models.

Results: After laparoscopic surgery, the 8.1% of patients required hospitalization. This rate was significantly superior in gynecologic surgery, patients with previous surgery complications, superior ASA classified (II and III) and smokers. Likewise, patients with pneumoperitoneum time over 45minutes presented a higher hospitalization rate; also founded in patients with anesthetic or surgery complications (including conversion to laparotomy). At least, the rate of hospitalization was significantly superior in relation with postoperative nausea and vomiting (PONV).

Conclusion: The rate of patients who need hospitalization after ambulatory laparoscopic surgery was 8.1%, of which 5.5% were general surgeries and 12.1% were gynecologic surgeries. The mots relationated factors with ambulatory manage failure, analyzed with multiple regression, were the appearance of surgery complications, the pneumoperitoneum time over 100minutes and the PONV.

Keywords: Ambulatory surgery; Cirugía ambulatoria; Laparoscopia; Laparoscopic; Nausea and vomiting postoperative; Neumoperitoneo artificial; Náuseas y vómitos postoperatorios; Pneumoperitoneum artificial.