UNSCHEDULED HOSPITAL ADMISSION FOLLOWING AMBULATORY GYNECOLOGIC LAPAROSCOPIC SURGERY

The objective of this study was to identify factors that may predict p atients at risk for unscheduled admission following ambulatory gynecol ogic laparoscopic surgery and to identify specific complications that may be associated with unscheduled admission. Each patient admitted on an unscheduled basis was compared to 2 patients who did not require a dmission. Thirty-one demographic and clinical factors were evaluated b y univariate analysis. Significant factors (p < 0.05) were then analyz ed using multivariate stepwise logistic regression. During a 6-year pe riod, 80 patients required unscheduled admission. This represents 4.61 % of 1732 patients who underwent ambulatory gynecologic laparoscopic s urgery. Factors associated with admission by multivariate analysis inc luded (1) previous laparotomy, (2) significant medical illnesses, (3) history of pelvic inflammatory disease, (4) major operative laparoscop y, and (5) increased surgical blood loss. Sensitivity was 53.8%, speci ficity was 90.0%, and the overall correct rate of prediction was 77.9% . Postoperative emesis was the most common cause for unscheduled admis sions and occurred in 27.1% of patients. Postoperative pain accounted for an additional 20% of admissions. Previous laparotomy, significant medical illnesses, and history of pelvic inflammatory disease are fact ors that cannot be altered preoperatively. Surgical blood loss, a func tion of the procedure, cannot be modified easily. Major operative gyne cologic laparoscopic surgery is extensive and may be associated with d elayed recovery. Postoperative emesis and pain management may warrant further investigation. Successful antiemetic therapy and effective con trol of postoperative pain have the potential to reduce unscheduled ad missions by almost 50%.