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Predicting surgical factors for unplanned overnight admission in ambulatory arthroscopic surgery of the knee: a prospective cohort in one hundred and eighty four patients

PURPOSE: Unplanned overnight admission (UOA) is an important indicator for quality of care with ambulatory knee arthroscopic surgery (AKAS). However, few studies have explored the factors related to the UOA and how to predict UOA after AKAS. This study aimed to evaluate the effectiveness of a standa...

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Autores principales: Saengpetch, Nadhaporn, Watcharopas, Ratthapoom, Kujkunasathian, Chusak, Limitloahaphan, Chalermchai, Lertbutsayanukul, Chatchawan, Vijittrakarnrung, Chaiyanun, Sa-ngasoongsong, Paphon, Arnuntasupakul, Vanlapa, Sangkum, Lisa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9110279/
https://www.ncbi.nlm.nih.gov/pubmed/35578111
http://dx.doi.org/10.1007/s00264-022-05436-8
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author Saengpetch, Nadhaporn
Watcharopas, Ratthapoom
Kujkunasathian, Chusak
Limitloahaphan, Chalermchai
Lertbutsayanukul, Chatchawan
Vijittrakarnrung, Chaiyanun
Sa-ngasoongsong, Paphon
Arnuntasupakul, Vanlapa
Sangkum, Lisa
author_facet Saengpetch, Nadhaporn
Watcharopas, Ratthapoom
Kujkunasathian, Chusak
Limitloahaphan, Chalermchai
Lertbutsayanukul, Chatchawan
Vijittrakarnrung, Chaiyanun
Sa-ngasoongsong, Paphon
Arnuntasupakul, Vanlapa
Sangkum, Lisa
author_sort Saengpetch, Nadhaporn
collection PubMed
description PURPOSE: Unplanned overnight admission (UOA) is an important indicator for quality of care with ambulatory knee arthroscopic surgery (AKAS). However, few studies have explored the factors related to the UOA and how to predict UOA after AKAS. This study aimed to evaluate the effectiveness of a standardized peri-operative protocol for the AKAS and identify whether a correlation exists between the peri-operative surgical factors and UOA in the patients undergoing AKAS. We hypothesized that more surgical invasiveness and prolong tourniquet time increase the risk of UOA after AKAS. METHOD: A prospective cohort study was conducted between October 2017 and March 2021. All 184 patients operated on standard AKAS protocol. The UOA is defined as overnight hospitalization of a patient undergoing AKAS. Demographic and peri-operative data were recorded, and the procedure was categorized based on the surgical invasiveness based on less invasive (intra-articular soft tissue surgery) (n = 65) and more complex surgery (involving extra-articular soft tissue surgery or ligamentous reconstruction) (n = 119). The clinical risk factors for UOA were identified and analyzed with multivariate analysis. RESULTS: The incidence of UOA in the more complex group (n = 7, 14.3%) was significantly higher than in the less invasive group (n = 3, 4.6%) (p = 0.049). The peri-operative factors significantly associated with UOA were age, more complex surgery, and longer tourniquet time (p < 0.10 all). However, the multivariate analysis revealed that longer tourniquet time was the only significant predictor for UOA (OR = 1.045, 95% CI = 1.022–1.067, p = 0.0001). The optimal cut-off points of tourniquet time for predicting UOA with the highest Youden index in the less invasive and more complex groups were 56 minutes and 107 minutes, respectively. CONCLUSION: The UOA after AKAS is more common in more complex surgery compared to less invasive surgery. This study showed that unplanned admission significantly associated with many factors—as patient factors, surgical invasiveness, and tourniquet time. However, tourniquet time is the only independent predictor for UOA. Therefore, strict perioperative management protocol must be applied in AKAS, and all patients having these risk factors should be prepared for UOA.
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spelling pubmed-91102792022-05-17 Predicting surgical factors for unplanned overnight admission in ambulatory arthroscopic surgery of the knee: a prospective cohort in one hundred and eighty four patients Saengpetch, Nadhaporn Watcharopas, Ratthapoom Kujkunasathian, Chusak Limitloahaphan, Chalermchai Lertbutsayanukul, Chatchawan Vijittrakarnrung, Chaiyanun Sa-ngasoongsong, Paphon Arnuntasupakul, Vanlapa Sangkum, Lisa Int Orthop Original Paper PURPOSE: Unplanned overnight admission (UOA) is an important indicator for quality of care with ambulatory knee arthroscopic surgery (AKAS). However, few studies have explored the factors related to the UOA and how to predict UOA after AKAS. This study aimed to evaluate the effectiveness of a standardized peri-operative protocol for the AKAS and identify whether a correlation exists between the peri-operative surgical factors and UOA in the patients undergoing AKAS. We hypothesized that more surgical invasiveness and prolong tourniquet time increase the risk of UOA after AKAS. METHOD: A prospective cohort study was conducted between October 2017 and March 2021. All 184 patients operated on standard AKAS protocol. The UOA is defined as overnight hospitalization of a patient undergoing AKAS. Demographic and peri-operative data were recorded, and the procedure was categorized based on the surgical invasiveness based on less invasive (intra-articular soft tissue surgery) (n = 65) and more complex surgery (involving extra-articular soft tissue surgery or ligamentous reconstruction) (n = 119). The clinical risk factors for UOA were identified and analyzed with multivariate analysis. RESULTS: The incidence of UOA in the more complex group (n = 7, 14.3%) was significantly higher than in the less invasive group (n = 3, 4.6%) (p = 0.049). The peri-operative factors significantly associated with UOA were age, more complex surgery, and longer tourniquet time (p < 0.10 all). However, the multivariate analysis revealed that longer tourniquet time was the only significant predictor for UOA (OR = 1.045, 95% CI = 1.022–1.067, p = 0.0001). The optimal cut-off points of tourniquet time for predicting UOA with the highest Youden index in the less invasive and more complex groups were 56 minutes and 107 minutes, respectively. CONCLUSION: The UOA after AKAS is more common in more complex surgery compared to less invasive surgery. This study showed that unplanned admission significantly associated with many factors—as patient factors, surgical invasiveness, and tourniquet time. However, tourniquet time is the only independent predictor for UOA. Therefore, strict perioperative management protocol must be applied in AKAS, and all patients having these risk factors should be prepared for UOA. Springer Berlin Heidelberg 2022-05-17 2022-09 /pmc/articles/PMC9110279/ /pubmed/35578111 http://dx.doi.org/10.1007/s00264-022-05436-8 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Paper
Saengpetch, Nadhaporn
Watcharopas, Ratthapoom
Kujkunasathian, Chusak
Limitloahaphan, Chalermchai
Lertbutsayanukul, Chatchawan
Vijittrakarnrung, Chaiyanun
Sa-ngasoongsong, Paphon
Arnuntasupakul, Vanlapa
Sangkum, Lisa
Predicting surgical factors for unplanned overnight admission in ambulatory arthroscopic surgery of the knee: a prospective cohort in one hundred and eighty four patients
title Predicting surgical factors for unplanned overnight admission in ambulatory arthroscopic surgery of the knee: a prospective cohort in one hundred and eighty four patients
title_full Predicting surgical factors for unplanned overnight admission in ambulatory arthroscopic surgery of the knee: a prospective cohort in one hundred and eighty four patients
title_fullStr Predicting surgical factors for unplanned overnight admission in ambulatory arthroscopic surgery of the knee: a prospective cohort in one hundred and eighty four patients
title_full_unstemmed Predicting surgical factors for unplanned overnight admission in ambulatory arthroscopic surgery of the knee: a prospective cohort in one hundred and eighty four patients
title_short Predicting surgical factors for unplanned overnight admission in ambulatory arthroscopic surgery of the knee: a prospective cohort in one hundred and eighty four patients
title_sort predicting surgical factors for unplanned overnight admission in ambulatory arthroscopic surgery of the knee: a prospective cohort in one hundred and eighty four patients
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9110279/
https://www.ncbi.nlm.nih.gov/pubmed/35578111
http://dx.doi.org/10.1007/s00264-022-05436-8
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