Study objective: To determine the rate of unanticipated admissions and readmissions, and to characterize the associated reasons and costs.
Design: Retrospective medical records database analysis.
Setting: University teaching hospital.
Patients: Any patient undergoing same day surgery (SDS) during a 12-month period.
Measurements: All nonelective return visits to the hospital within 30 days and the reasons for return were identified.
Main results: There were a total of 20,817 patients who underwent SDS in 1999; 1,195 (5.7%) of these returned to the hospital within 30 days or were admitted directly after surgery. Of those unanticipated admissions and readmissions, 313 (1.5%) were directly related to the original SDS procedure. The mean age of these patients was 51 years, 164 (52%) were female, and 266 (85%) were Caucasian. Pain was the most commonly reported reason for return, occurring in 120 (38%) patients who had an unanticipated admission or readmission. After controlling for SDS volume, the general surgery service had the highest rate of unanticipated admissions or readmissions (3.2%), followed by otolaryngology (3.1%) and urology (2.9%). Of the 120 patients returning with unanticipated admissions and readmissions due to pain, 46 (38%) had orthopedic procedures during their index SDS. Mean charges for patients with unanticipated admissions and readmission due to pain were $1,869 +/- $4,553 per visit, whereas charges for nonpain related readmissions were $12,000 +/- $36,886.
Conclusion: At our teaching institution, approximately 1.5% of patients undergoing outpatient ambulatory surgery return within 30 days due to problems directly related to the original surgical procedure. Pain accounted for more than one third of return visits, incurring significant costs. Efforts to manage pain should focus not only on pain in the hospital but also anticipation of pain-related issues on discharge.