WHAT HAPPENS AFTER-DISCHARGE - RETURN HOSPITAL VISITS AFTER AMBULATORY SURGERY

The purpose of this study was to examine the frequency of return hospi tal visits after ambulatory surgery discharge and to identify any pred ictor variables for its occurrence. A retrospective review of hospital records for all patients returning to the same hospital within 30 day s after ambulatory surgery was conducted. Data an return hospital visi ts that resulted in rehospitalization (as an inpatient or to the ambul atory surgery unit [ASU]) or treatment as an outpatient in the emergen cy room were recorded. A total of 6243 patients underwent ambulatory s urgery over 12 consecutive months and 187 returned to the same hospita l of which 1.3% were for complications. Of all the returns, 54% return ed to the emergency room (ER) and 46% were rehospitalized as inpatient s or to ASU. To identify factors associated with an increased Likeliho od of return, two case controls for each return visit were obtained fr om medical records of ambulatory surgical patients operated on during the same time period. Results of the multivariate analysis on the matc hed case controls identified urology as the only significant surgical service that predicted returns. (Odds ratio 27.87; confidence interval [CI] 3.78-74.86; P = 0.0002). A separate analysis of the most common ASU procedures performed identified two surgical procedures that predi cted hospital return as compared with overall ambulatory surgery popul ation: patients undergoing varicocelectomy and hydrocelectomy procedur es were 8.3 times more likely to return (CI 2.090-23.75; P = 0.0042); patients undergoing dilation and curettage were three times as likely to return (CI 1.78-5.55; P = 0.0002). Bleeding was the most common rea son for all hospital returns (41.5%), with 76.5% of these patients tre ated and discharged through the ER. The increased likelihood of return visits after urology procedures warrants further evaluation. As patie nts with bleeding were most likely to return to the ER and discharged, more effective pre- and postprocedure patient education may further r educe this occurrence. Better informing patients regarding the prognos is of bleeding, and advising them of medical alternatives, could reduc e inappropriate patient returns to the ER.