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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.

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. [ABSTRACT FROM AUTHOR]

Abstract Background Unplanned ICU admission after surgery has been validated as a measure of a quality indicator of perioperative management because it may put surgical patients at risk of increased morbidity and mortality. Postoperative unscheduled admission to the ICU is usually determined either in the post-anesthesia care unit (PACU) or in the general surgical ward; however, it could be expected patient outcomes after ICU admission would be affected by the circumstances. The purpose of this retrospective observational study was to investigate the clinical characteristics and the outcome of unplanned admission to the ICU directly from the PACU or from the ward within 7 days after PACU discharge. Methods Forty-three thousand, five hundred fifty-three patients admitted to the PACU after general anesthesia were included in the study. Unplanned ICU admission was defined as the admission which was not anticipated preoperatively but was due to adverse events in the PACU (PACU group) or the ward after discharge from the PACU (Ward group). The following parameters were compared between the groups: patient characteristics, surgical characteristics, length of ICU and hospital stay, the principal adverse event for ICU admission, treatments in the ICU, and in-hospital mortality. The primary outcome was in-hospital mortality and the second was the length of ICU and hospital stay. Results Among 43,553 patients, 109 patients underwent unplanned ICU admission directly from the PACU (n= 73, 0.17%) or subsequently from the ward (n= 36, 0.08%). The length of both ICU and hospital stay was significantly longer in the Ward group than in the PACU group (1.4 and 19 days vs. 2.5 and 39 days, respectively). There was no significant difference in in-hospital mortality between the groups (4.1% vs. 8.3%, respectively). Conclusions The incidence of unplanned ICU admission after PACU stay was low, however, delayed admission to the ICU from the ward may prolong the length of both ICU and hospital stay compared to those directly from the PACU.

Background: Unplanned ICU admission after surgery has been validated as a measure of a quality indicator of perioperative management because it may put surgical patients at risk of increased morbidity and mortality. Postoperative unscheduled admission to the ICU is usually determined either in the post-anesthesia care unit (PACU) or in the general surgical ward; however, it could be expected patient outcomes after ICU admission would be affected by the circumstances. The purpose of this retrospective observational study was to investigate the clinical characteristics and the outcome of unplanned admission to the ICU directly from the PACU or from the ward within 7 days after PACU discharge. Methods: Forty-three thousand, five hundred fifty-three patients admitted to the PACU after general anesthesia were included in the study. Unplanned ICU admission was defined as the admission which was not anticipated preoperatively but was due to adverse events in the PACU (PACU group) or the ward after discharge from the PACU (Ward group). The following parameters were compared between the groups: patient characteristics, surgical characteristics, length of ICU and hospital stay, the principal adverse event for ICU admission, treatments in the ICU, and in-hospital mortality. The primary outcome was in-hospital mortality and the second was the length of ICU and hospital stay. Results: Among 43,553 patients, 109 patients underwent unplanned ICU admission directly from the PACU (n= 73, 0.17%) or subsequently from the ward (n= 36, 0.08%). The length of both ICU and hospital stay was significantly longer in the Ward group than in the PACU group (1.4 and 19 days vs. 2.5 and 39 days, respectively). There was no significant difference in in-hospital mortality between the groups (4.1% vs. 8.3%, respectively). Conclusions: The incidence of unplanned ICU admission after PACU stay was low, however, delayed admission to the ICU from the ward may prolong the length of both ICU and hospital stay compared to those directly from the PACU. [ABSTRACT FROM AUTHOR]

Background: Advances in surgery and anesthesia have paved the way for the establishment of day-care surgery (DCS). Observations that children achieve better convalescence in the home environment along with significant economic advantages have led to this paradigm shift in clinical practice. Aims and Objectives: This study is aimed to evaluate the feasibility of performing various surgical procedures on day-care basis and assess parental satisfaction with DCS in children. Materials and Methods: In this prospective observational study, all children >3 months of age undergoing various elective surgical procedures as day-care cases in our institution were enrolled. Types of operations, complications, including any unplanned admissions and parental satisfaction, were recorded. Results: Between December 2015 and December 2018, a total of 654 day-care surgeries were performed in our institution by pediatric surgeons. The mean age was 5.5 years with M: F 5.5:1. Thirty different surgical procedures were successfully performed as DCS, the common procedures being inguinal herniotomy (31.5%), and orchidopexy (14.3%). Unplanned admissions were recorded in 2.29% (15/654) patients (scrotal edema-5, postoperative pain-8, and a long recovery from anesthesia-2). No major complications occurred; two minor complications during follow-up were superficial wound infection and drug reaction. Overall parental satisfaction was very high (100%)-preoperative prolonged fasting period and long waiting time in the preoperative room of afternoon shift patients (7.95% and 8.3%) were the reasons for their discontent. Conclusions: DCS in children is safe and effective with high parental satisfaction. It can substantially reduce the waiting list for several surgical procedures in children.

Background: Advances in surgery and anesthesia have paved the way for the establishment of day-care surgery (DCS). Observations that children achieve better convalescence in the home environment along with significant economic advantages have led to this paradigm shift in clinical practice. Aims and Objectives: This study is aimed to evaluate the feasibility of performing various surgical procedures on day-care basis and assess parental satisfaction with DCS in children. Materials and Methods: In this prospective observational study, all children >3 months of age undergoing various elective surgical procedures as day-care cases in our institution were enrolled. Types of operations, complications, including any unplanned admissions and parental satisfaction, were recorded. Results: Between December 2015 and December 2018, a total of 654 day-care surgeries were performed in our institution by pediatric surgeons. The mean age was 5.5 years with M: F 5.5:1. Thirty different surgical procedures were successfully performed as DCS, the common procedures being inguinal herniotomy (31.5%), and orchidopexy (14.3%). Unplanned admissions were recorded in 2.29% (15/654) patients (scrotal edema-5, postoperative pain-8, and a long recovery from anesthesia-2). No major complications occurred; two minor complications during follow-up were superficial wound infection and drug reaction. Overall parental satisfaction was very high (100%)-preoperative prolonged fasting period and long waiting time in the preoperative room of afternoon shift patients (7.95% and 8.3%) were the reasons for their discontent. Conclusions: DCS in children is safe and effective with high parental satisfaction. It can substantially reduce the waiting list for several surgical procedures in children. [ABSTRACT FROM AUTHOR]

Background and Purpose: Despite the growing demands and challenges faced by patients with amyotrophic lateral sclerosis (ALS) in accessing healthcare services, our understanding of this access remains poor. This study aimed to investigate the healthcare utilization patterns and timing of nutritional and respiration support in patients with ALS in South Korea., Methods: A retrospective cohort study was conducted on patients diagnosed with ALS at a single tertiary hospital between 2016 and 2019 and followed up for 2 years. We evaluated patient characteristics, healthcare utilization (hospital admissions, outpatient visits, and emergency department [ED] visits), and the timing of nutritional and respiration support (noninvasive positive pressure ventilation [NIPPV], tracheostomy, gastrostomy, and nasogastric tube) at 6-month intervals from the first outpatient visit., Results: Among the 143 included patients, 73.4% were admitted at least once, 18.9% experienced unplanned admissions, and 30.1% visited the ED at least once during the study period. The most-common reason for ED visits was neurological symptoms during the first 6 months (59.1%), followed by respiratory symptoms. One fifth of patients who visited the ED underwent tracheostomy (20.9%) or NIPPV (20.9%). Two years after the first visit, 32.2% used a ventilator, and 13.3%, 26.6%, and 6.3% had undergone tracheostomy, gastrostomy, and nasogastric tube insertion, respectively., Conclusions: During the 2 years following their first outpatient visit, 20% of patients with ALS experienced unplanned admissions and 30% visited the ED. An active and prompt supportive-care program should be implemented to ensure timely functional support in order to reduce these risks of unplanned admissions., Competing Interests: The authors have no potential conflicts of interest to disclose., (Copyright © 2024 Korean Neurological Association.)

Abstract Background Failure to promptly identify deterioration in hospitalised patients is associated with delayed admission to intensive care units (ICUs) and poor outcomes. Existing vital sign-based Early Warning Score (EWS) algorithms do not have a sufficiently high positive predictive value to be used for automated activation of an ICU outreach team. Incorporating additional patient data might improve the predictive power of EWS algorithms; however, it is currently not known which patient data (or variables) are most predictive of ICU admission. We describe the protocol for a systematic review of variables associated with ICU admission. Methods/design MEDLINE, EMBASE, CINAHL and the Cochrane Library, including Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials (CENTRAL) will be searched for studies that assess the association of routinely recorded variables associated with subsequent unplanned ICU admission. Only studies involving adult patients admitted to general ICUs will be included. We will extract data relating to the statistical association between ICU admission and predictor variables, the quality of the studies and the generalisability of the findings. Discussion The results of this review will aid the development of future models which predict the risk of unplanned ICU admission. Systematic review registration PROSPERO: CRD42015029617

People with dementia (PWD) and cognitive impairment are particularly vulnerable to medication problems, and unplanned admission to hospital presents an opportunity to address polypharmacy, potentially inappropriate medications (PIMs) and anticholinergic burden. This study aimed to compare PIMS and other medication data for PWD to determine whether these changed during hospitalization. Medications documented in patient’s records at admission and discharge were evaluated for PWD recruited to phase one of a prospective quasi-experimental pre/post-controlled trial that was conducted at two regional hospitals in NSW, Australia. The study sample included PWD or cognitive impairment having an unplanned admission to hospital. Data were collected using a purpose developed audit tool for medications and PIMs, and a Modified Anticholinergic Burden Scale. Total participants were 277, and results determined that the cognitive status of PWD is not always detected during an unplanned admission. This may make them more vulnerable to medication problems and poor outcomes. Polypharmacy and PIMS for PWD were high at admission and significantly reduced at discharge. However, PWD should be routinely identified as high risk at admission; and there is potential to further reduce polypharmacy and PIMs during admission to hospital, particularly psychotropic medications at discharge. Future studies should focus on evaluating targeted interventions designed to increase medication safety for PWD.

Se realizó un estudio descriptivo y retrospectivo de 109 pacientes, atendidos en la Unidad de Cuidados Intensivos del Hospital General Universitario "Vladimir Ilich Lenin" de Holguín, desde septiembre de 2006 hasta igual mes de 2007, con vistas a determinar la frecuencia de los ingresos no planificados en ese Servicio. La información necesaria se obtuvo de los expedientes clínicos y del libro de registro de hospitalización. En la casuística predominaron los integrantes que se encontraban en el periodo posquirúrgico (39,4 %), en tanto la sepsis/disfunción múltiple de órganos (25,7 %) constituyeron las causas más comunes del internamiento urgente. La aparición de complicaciones no esperadas incrementó su frecuencia (43,0 %), con predictores de gravedad (APACHE II) superiores (66,0 %) respecto a los programados.A descriptive and retrospective study of 109 patients, assisted in the Intensive Care Unit from "Vladimir Ilich Lenin" University General Hospital in Holguín was carried out from September, 2006 to the same month of 2007, with the objective of determining the frequency of the unplanned admissions in that Service. The necessary information was obtained from the clinical records and the registration book from the hospital. The patients who were in the postsurgical period prevailed (39.4%), while sepsis/multiple organs dysfunction (25.7%) constituted the most common causes for the admission. The occurrence of unexpected complications increased its frequency (43.0%), with higher severity predictors (66.0%), (APACHE II), compared to the scheduled cases.

To identify the risk factors associated with unplanned admission after day-case haemorrhoidectomy. Methods: This was a retrospective review of the outcomes of patients who underwent elective, intended day-case haemorrhoidectomy in a surgical institution between January 2005 and December 2009. Data were generated from a computerized database. Information on patient demographics, type of surgery, mode of anaesthesia, operative time, operation end time, and perioperative drugs were collected and analysed. Unplanned admission was carefully recorded. Results: In a 5-year period, 243 patients underwent intended day-case haemorrhoidectomy. Of these, 43 (17.7%) had unplanned admission, with acute urinary retention as the most common cause (n = 30). Using univariate analysis, male gender, the use of spinal anaesthesia, and a late operation end time of after 2 PM were found to be positive risk factors associated with unplanned admission, whereas the use of single-dose dexamethasone during induction was identified as having a negative effect on unplanned admission. However, multivariate analysis showed that only male gender, the use of spinal anaesthesia, and a late operation end time of after 2 PM were independent risk factors. Conclusion: Good operation listing and the use of general anaesthesia are recommended in the practice of day-case haemorrhoidectomy.

Background: In England, between 2007/8 and 2009/10, the rate of unplanned hospital admissions of people aged 85 years and above rose from 48 to 52 per 100. There was substantial variation, with some areas showing a much faster rate of increase and others showing a decline. Objectives: To identify system characteristics associated with higher and lower increases in unplanned admission rates in those aged 85 years and over; to develop recommendations to inform providers and commissioners; and to investigate the challenges of starting to implement these recommendations. Design: Mixed-methods study using routinely collected data, in-depth interviews and focus groups. Data were analysed using the framework approach, with themes following McKinsey’s 7S model. Recommendations derived from our findings were refined and prioritised through respondent validation and consultation with the project steering group. The process of beginning to implement these recommendations was examined in one ‘implementation site’. Participants: Six study sites were selected based on admission data for patients aged 85 years and above from primary care trusts: three where rates of increase were among the most rapid and three where they had slowed down or declined. Each ‘improving’ or ‘deteriorating’ site comprised an acute hospital trust, its linked primary care trust/clinical commissioning group, the provider of community health services, and adult social care. At each site, representatives from these organisations at strategic and operational levels, as well as representatives of patient groups, were interviewed to understand how policies had been developed and implemented. A total of 142 respondents were interviewed. Results: Between 2007/8 and 2009/10, average admission rates for people aged 85 years and over rose by 5.5% annually in deteriorating sites and fell by 1% annually in improving sites. During the period under examination, the population aged 85 years and over in deteriorating sites increased by 3.4%, compared with 1.3% in improving sites. In deteriorating sites, there were problems with general practitioner access, pressures on emergency departments and a lack of community-based alternatives to admission. However, the most striking difference between improving and deteriorating sites was not the presence or absence of specific services, but the extent to which integration within and between types of service had been achieved. There were also overwhelming differences in leadership, culture and strategic development at the system level. The final list of recommendations emphasises the importance of issues such as maximising integration of services, strategic leadership and adopting a system-wide approach to reconfiguration. Conclusions: Rising admission rates for older people were seen in places where several parts of the system were under strain. Places which had stemmed the rising tide of admissions had done so through strong, stable leadership, a shared vision and strategy, and common values across the system. Future work: Research on individual components of care for older people needs to take account of their impact on the system as a whole. Areas where more evidence is needed include the impact of improving access and continuity in primary care, the optimal capacity for intermediate care and how the frail elderly can best be managed in emergency departments. Study registration: UK Clinical Reasearch Network 12960. Funding details: The National Institute for Health Research Health Services and Delivery Research programme.

A descriptive and retrospective study of 109 patients, assisted in the Intensive Care Unit from "Vladimir Ilich Lenin" University General Hospital in Holguín was carried out from September, 2006 to the same month of 2007, with the objective of determining the frequency of the unplanned admissions in that Service. The necessary information was obtained from the clinical records and the registration book from the hospital. The patients who were in the postsurgical period prevailed (39.4%), while sepsis/multiple organs dysfunction (25.7%) constituted the most common causes for the admission. The occurrence of unexpected complications increased its frequency (43.0%), with higher severity predictors (66.0%), (APACHE II), compared to the scheduled cases. [ABSTRACT FROM AUTHOR]

Objectives: Unplanned intensive care unit (ICU) admissions are associated with near-miss events, morbidity, and mortality. We describe the rate, resource utilization, and outcomes of paediatric patients urgently admitted directly to ICU post-anaesthesia compared to other sources of unplanned ICU admissions., Methods: We performed a secondary analysis of data from specialist paediatric hospitals in 7 countries. Patients urgently admitted to the ICU post-anaesthesia were combined and matched with 1 to 3 unique controls from unplanned ICU admissions from other locations by age and hospital. Demographic, clinical, and outcome variables were compared using the Wilcoxon rank-sum test for continuous variables and chi-square or Fisher's exact test for categorical variables. The effect of admission sources on binary outcomes was estimated using univariable conditional logistic regression models with stratification by matched set of anaesthesia and non-anaesthesia admission sources., Results: Most admissions were <1 year of age and for respiratory reasons. Admissions post-anaesthesia were shorter, occurred later in the day, and were more likely to be mechanically ventilated. Admissions post-anaesthesia were less likely to have had a previous ICU admission (4.8% compared to 11%, P=0.032) or PIM 'high-risk diagnosis' (9.5% versus 17.2%, P=0.035) but there was no difference in the number of subsequent ICU admissions. There was no difference in the PIM severity of illness score and no mortality difference between the groups., Conclusions: Young children and respiratory indications dominated unplanned ICU admissions post-anaesthesia, which was more likely later in the day and with mechanical ventilation., (© The Author(s) 2022. Published by Oxford University Press on behalf of the Canadian Paediatric Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Abstract: Introduction: The drive to achieving economy, efficiency and effective use of resources has catalysed the development of day case laparoscopic cholecystectomy (DCLC). The aims of this study were to determine the stay in (unplanned admission) rate of DCLC, identify reasons for unplanned admissions and re-admissions in this cohort of patients and explore how to improve the same day discharge rate. Patients and Methods: This is a review of 258 patients undergoing DCLC between April 2008 and March 2009. Information on these patients were retrieved and analysed for their effect on unplanned admission. Statistical analyses were performed using SPSS for Windows as appropriate. Results: There were 201 females and 57 males with mean ages of 44.23 ± 1.02 and 52.0 ± 1.83 respectively. Fifty six percent of patients had no major co-morbidities and 51% of operations were performed by consultants compared to 48% by Registrars (SpRs). The mean operation time was 50.92 ± 1.55 min for consultants and 61.36 ± 2.03 for SpRs (p = 0.0001). Sixty nine percent of the patients were discharged on same day after DCLC. The rate of admission was 29.4% for biliary colic, 37.7% for cholecystitis and 75% for those previously jaundiced. Admissions were mainly due to insertion of a drain and late operation start time. Conclusion: Appropriate patient selection, sensible scheduling of operations and avoiding the use of drains will decrease unplanned admissions following DCLC. Although the time taken to perform procedures was higher for surgical trainees than consultants, this had no adverse outcome on patient outcome. [ABSTRACT FROM AUTHOR]

Objective: To identify the risk factors associated with unplanned admission after day-case haemorrhoidectomy. Methods: This was a retrospective review of the outcomes of patients who underwent elective, intended day-case haemorrhoidectomy in a surgical institution between January 2005 and December 2009. Data were generated from a computerized database. Information on patient demographics, type of surgery, mode of anaesthesia, operative time, operation end time, and perioperative drugs were collected and analysed. Unplanned admission was carefully recorded. Results: In a 5-year period, 243 patients underwent intended day-case haemorrhoidectomy. Of these, 43 (17.7%) had unplanned admission, with acute urinary retention as the most common cause (n = 30). Using univariate analysis, male gender, the use of spinal anaesthesia, and a late operation end time of after 2 PM were found to be positive risk factors associated with unplanned admission, whereas the use of single-dose dexamethasone during induction was identified as having a negative effect on unplanned admission. However, multivariate analysis showed that only male gender, the use of spinal anaesthesia, and a late operation end time of after 2 PM were independent risk factors. Conclusion: Good operation listing and the use of general anaesthesia are recommended in the practice of day-case haemorrhoidectomy. [ABSTRACT FROM AUTHOR]

The Global Leadership Initiative on Malnutrition (GLIM) criteria are consensus criteria for the diagnosis of malnutrition. This study aimed to investigate and compare the prevalence of malnutrition using the GLIM, European Society for Clinical Nutrition and Metabolism (ESPEN) and International Statistical Classification of Diseases version 10 (ICD-10) criteria; compare the level of agreement between these criteria; and identify the predictive validity of each set of criteria with respect to 30-day outcomes in a large cancer cohort. GLIM, ESPEN and ICD-10 were applied to determine the prevalence of malnutrition in 2794 participants from two cancer malnutrition point prevalence studies. Agreement between the criteria was analysed using the Cohen's Kappa statistic. Binary logistic regression models were used to determine the ability of each set of criteria to predict 30-day mortality and unplanned admission or readmission. GLIM, ESPEN and ICD-10 criteria identified 23.0%, 5.5% and 12.6% of the cohort as malnourished, respectively. Slight-to-fair agreement was reported between the criteria. All three criteria were predictive of mortality, but only the GLIM and ICD-10 criteria were predictive of unplanned admission or readmission at 30 days. The GLIM criteria identified the highest prevalence of malnutrition and had the greatest predictive ability for mortality and unplanned admission or readmission in an oncology population. [ABSTRACT FROM AUTHOR]