Abstract
To understand better the factors important to the safety of anaesthesia provided for day surgical procedures, we analyzed the intraoperative and immediate postoperative course of patients at four Canadian teaching hospitals ’ day treatment centres. After excluding those who received only monitored anaesthesia care, there were 6,914 adult (non-obstetrical) patients seen over a twelve-month period in 1988–89. The rate of adverse outcome consequent to their care was identified by a comprehensive surveillance system which included review of anaesthetic records (four hospitals) and follow-up telephone calls (two hospitals). The relationship between adverse events and preoperative factors was determined by using a multiple logistic regression analysis that included age, sex, duration of the procedure and the hospital care. There were no deaths during the study period and major morbid events were infrequent. Patient preoperative disease was predictive of some intraoperative events relating to the same organ system, but not to events in the PACU. Some unexpected relationships emerged including preoperative hypertension being related to a greater risk of difficult intubation, and neurological disease to perioperative cardiac abnormalities. Patients judged obese, or inadequately fasted, were found to experience a greater rate of recovery problems as well as discomfort. While the low response rate (36%) to the telephone interviews created a sampling bias, the high rate of patient dissatisfaction among those reached is disconcerting. We conclude that day surgical patients with preoperative medical conditions, even when optimally managed, are at higher risk for adverse events in the perioperative period.
Résumé
Afin de mieux comprendre les facteurs importants pour la sécurité de l’anesthésie prodiguée en chirurgie ambulatoire, nous avons analysé le décours intra-opératoire en post-opératoire immédiat chez les patients des centres de chirurgie ambulatoire de quatre hopitaux d’enseignement canadiens. Après exclusion des cas n ’ayant nécessité qu ’une surveillance anesthésique, il y avait 6914 patients adultes (non obstétricaux) pour une période de douze mois en 1988–89. Le taux d’issues défavorables secondaires aux soins a été identifié par un systeme de surveillance d’ensemble qui incluait la révision des dossiers anesthésiques (quatre hôpitaux) et des appels téléphoniques pour assurer le suivi (deux hôpitaux). La relation entre les événements défavorables et les facteurs pré-opératoires était déterminée par une analyse de régression logistique multiple qui incluait l’age, le sexe, la durée de l’intervention et l’hôpital ayant fourni les soins. Il n’y a pas eu de décès durant la periode de l’étude et les événements morbides majeurs ont été peu fréquents. La maladie du patient en préopératoire était un facteur de prédiction de quelques événements intra-opératoires reliés au même système d’organes, mais ne l’était pas pour les événements survenus en salle de réveil. Quelques relations imprévues ont émergées dont la relation entre l’hypertension artérielle pré-opératoire et un plus grand risque a’intubation difficile, et la relation entre une maladie neurologique et les anomalies cardiaques en péri-opératoire. Les patients considérés obèses, ou sans jeûne adéquat, ont présentés un plus haut taux de problèmes au réveil et un plus grand inconfort. Bien que le faible taux de réponse (36%) aux entrevues téléphoniques a créé un biais d’échantillonnage, le haut taux d’insatisfaction des patients parmi ceux qui furent rejoints est déconcertant. En conclusion, les patients de chirurgie ambulatoire qui présentent des problèmes médicaux pré-opératoires, même lorsque traités de façon optimale, sont à plus haut risque de présenter des événements défavorables en période péri-opératoire.
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References
Weintraub HD. Patient selection for ambulatory surgery and when do we say no? Advances in Anaesthesia 1990; 6: 47–66.
Kitz DS, Slusary-Ladden C, Lecky JH. Hospital resources for inpatient and ambulatory surgery. Anesthesiology 1988; 69: 383–6.
McTaggart RA. Selection of patients for day care surgery. Can Anaesth Soc J 1983; 30: 543–5.
Saklad M. Grading of patients for surgical procedures. Anesthesiology 1941; 2: 281–5.
Cohen MM, Duncan PG, Tweed WA, et al. The Canadian four-centre study of anaesthetic outcomes: I. Description of methods and populations. Can J Anaesth 1992; 39: 420–9.
Cohen MM, Tate RB. Using the McGill pain question naire to study common postoperative complications. Pain 1989; 39: 275–9.
Pineault R, Contandriopoulos AP, Valois M, et al. Ran domized clinical trial of one-day surgery: patient satisfac tion, clinical outcomes and costs. Med Care 1985; 23: 171–82.
Fancourt-Smith PF, Hornstein J, Jenkins LG. Hospital admissions from the day care centre of the Vancouver General Hospital. Can J Anaesth 1990; 37: 699–704.
Postuma R, Ferguson CC, Stanwick RS, Horne JM. Pedi atric day-care surgery: a 30-year hospital experience. J Pediatric Surg 1987; 22: 304–7.
Natof HE. Complications associated with ambulatory surgery. JAMA 1980; 244: 1116–8.
Meridy HW. Criteria for selection of ambulatory surgery patients and guidelines for anesthetic management: a retrospective study of 1553 cases. Anesth Analg 1982; 61: 921–6.
Patel RI, Hannallah RS. Anesthetic complications follow ing pediatric ambulatory surgery: a 3-year study. Anes thesiology 1988; 69: 1009–12.
Roos NP. What is the potential for moving adult surgery to the ambulatory setting? Can Med Assoc J 1988; 138: 809–16.
Haworth EA, Balarajan R. Day surgery: does it add to or replace inpatient surgery? BMJ 1987; 294: 133–5.
David JE, Sugioka K. Selecting the patient for major ambulatory surgery. Surg Clin N Amer 1987; 67: 721–32.
Lagoe RJ.Bice SE, Abulencia PB. Ambulatory surgery utilization by age level. Am J Public Health 1987; 77: 33–7.
Kallar SK, Jones GW. Postoperative complications.In: White P (Ed.). Outpatient Anesthesia. New York: Chur chill Livingston, 1988; 397–415.
Duncan PG, Cohen MM. Anaesthetic morbidity: factors of significance to anaesthetic practice. Can J Anaesth 1987; 34: 2–8.
Detmer DE, Buchanan-Davidson DJ. Ambulatory sur gery.In: Rutkow, IM (Ed.). Socioeconomics of Surgery. St. Louis: C.V. Mosby, 1989; 31–50.
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Supported by a grant from the National Health Research Development Program, Health and Welfare Canada, and by a National Health Scholar Award (Health & Welfare Canada) to Dr. Cohen.
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Duncan, P.G., Cohen, M.M., Tweed, W.A. et al. The Canadian four-centre study of anaesthetic outcomes: III. Are anaesthetic complications predictable in day surgical practice?. Can J Anaesth 39, 440–448 (1992). https://doi.org/10.1007/BF03008707
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DOI: https://doi.org/10.1007/BF03008707