Factors contributing to a prolonged stay after ambulatory surgery

We identified predictors for prolonged postoperative stay after ambulatory surgery using multiple logistic regression models. We collected perioperati ve data for 16,411 ambulatory surgical patients. A log-transformed time to discharge variable was modeled by multiple linear regression, including pat ient-, anesthesia-, and surgery-specific variables. The impact of hypotheti cal elimination of perioperative adverse events on mean length of stay was also estimated. Separate analyses were performed among patients who receive d general anesthesia (GA) and monitored anesthesia care (MAC). Patients rec eiving GA stayed 50 min longer than patients receiving MAC. Patients receiv ing GA and undergoing strabismus, transurethral, or otorhinolaryngological/ dental procedures had the longest postoperative stay. Among patients receiv ing GA, smokers had a 4% shorter stay compared with nonsmokers;among patien ts receiving MAC, those with congestive heart failure (CHF) had a 11% longe r stay compared with patients without CHE Postoperative nausea and vomiting , dizziness, excessive pain, and cardiovascular events predicted 22%-79% in creases in postoperative stay. The hypothetical elimination of all adverse events resulted in a 9.6% decrease in mean length of stay among patients re ceiving GA, but in only a 3.8% decrease among patients receiving MAC. The l ength of postoperative stay among ambulatory surgical patients is mainly de termined by the type of surgery and by adverse events, such as excessive pa in, postoperative nausea and vomiting, dizziness, drowsiness, and cardiovas cular events. Patients with CHF and those who underwent long procedures had a higher risk of a prolonged stay. Appropriate prevention and management o f postoperative symptoms could significantly decrease the length of stay am ong patients receiving GA. Implications: The length of postoperative stay a mong ambulatory surgical patients is mainly determined by the type of surge ry and by adverse events, such as excessive pain, postoperative nausea and vomiting, dizziness, drowsiness, and untoward cardiovascular events. Patien ts with congestive heart failure and those who underwent long procedures ha d a higher risk of a prolonged stay. Appropriate prevention and management of postoperative symptoms could significantly decrease the length of stay a mong patients receiving general anesthesia.