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Inicio Cirugía Española (English Edition) Predictive factors of admission in outpatient laparoscopic surgery
Journal Information
Vol. 99. Issue 2.
Pages 140-146 (February 2021)
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Vol. 99. Issue 2.
Pages 140-146 (February 2021)
Original article
DOI: 10.1016/j.cireng.2021.01.003
Predictive factors of admission in outpatient laparoscopic surgery
Factores con valor predictivo de ingreso en cirugía laparoscópica ambulatoria
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Jaime López-Torres Lópeza,
Corresponding author
, Belén Cifuentes Garcíaa, Laura Fernández Ruipéreza, Alberto Rodeles Criadoa, María José Alcántara Noallesb, Ramón Peiró Garcíaa, Pilar Argente Navarrob
a Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, GAI de Albacete, Albacete, Spain
b Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitari i Politècnic La Fe de Valencia, Valencia, Spain
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Tables (5)
Table 1. Patient characteristics.
Table 2. Distribution of cases studied according to the reason for surgery (CIE-9).
Table 3. Distribution of patients according to anesthetic risk (ASA classification).
Table 4. Proportion of patients hospitalized, related to their surgical and anesthetic complications.
Table 5. Variables introduced in the logistic regression model whose variable was the need for hospital admission.
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Figures (1)
Abstract
Introduction

The aim of the study is to analyze the rate of unplanned 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 preoperative, intraoperative or postoperative factors. To identify risk factors and variables associated with complications, statistical analyses were calculated with logistic regression models.

Results

After laparoscopic surgery, 8.1% of patients required hospitalization. This rate was significantly superior in gynecologic surgery, patients with previous surgery complications, superior ASA score (II and III) and smokers. Likewise, patients with pneumoperitoneum time over 45minutes presented a higher hospitalization rate, also found in patients with anesthetic or surgery complications (including conversion to laparotomy). Finally, 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 most frequently related factors with failed ambulatory management, analyzed with multiple regression, were the appearance of surgery complications, pneumoperitoneum time over 100minutes and PONV.

Keywords:
Ambulatory surgery
Laparoscopic
Nausea and vomiting postoperative
Pneumoperitoneum artificial
Resumen
Introducción

El objetivo del estudio fue evaluar la tasa de ingreso no planificado tras cirugía laparoscópica ambulatoria e identificar factores relacionados con el fracaso de la ambulatorización en este tipo de pacientes.

Métodos

Estudio observacional prospectivo de 297 pacientes adultos intervenidos mediante cirugía laparoscópica en régimen ambulatorio en el Hospital Universitari i Politècnic La Fe de Valencia durante 18 meses. Como variable principal se consideró la necesidad de ingreso hospitalario el mismo día de la intervención. Como variables independientes se registraron factores preoperatorios, intraoperatorios y postoperatorios. Mediante regresión múltiple se comprobó la asociación de ingreso postoperatorio con sus factores condicionantes, realizando un ajuste estadístico por las posibles variables de confusión.

Resultados

Tras la cirugía laparoscópica el 8,1% de los pacientes precisó ingreso hospitalario. Esta proporción fue significativamente superior en las pacientes intervenidas de cirugía ginecológica, en los que habían presentado complicaciones en cirugías previas, en pacientes con un ASA superior y en fumadores, así como en quienes se prolongó el tiempo de neumoperitoneo por encima de 45minutos. También lo fue entre los pacientes que presentaron complicaciones anestésicas o quirúrgicas intraoperatorias. Por último, la proporción de pacientes ingresados fue significativamente superior cuando presentaron NVPO.

Conclusión

La proporción de pacientes que ingresaron tras cirugía laparoscópica ambulatoria fue del 8,1%, correspondiendo al 5,5% de los sometidos a cirugía general y al 12,1% de las sometidas a cirugía ginecológica. Los factores más relacionados con el fracaso ambulatorio fueron la presencia de complicaciones quirúrgicas, el tiempo de neumoperitoneo superior a 100minutos y la aparición de náuseas postoperatorias.

Palabras clave:
Cirugía ambulatoria
Laparoscopia
Náuseas y vómitos postoperatorios
Neumoperitoneo artificial

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