Outpatient tympanomastoidectomy - Factors affecting hospital admission

Background: Outpatient tympanomastoidectomy is common in many medical cente rs. However, failure of same-day discharge is often the result of postopera tive nausea and vomiting (PONV). Many times this leads to hospital admissio n after tympanomastoidectomy, and it is often difficult to predict before s urgery whether PONV will be an issue that impedes same-day discharge. Objective: To determine the clinical factors correlated with the incidence of PONV requiring hospital admission after chronic ear surgery by hypothesi zing that the complexity of a particular case, as measured using a 10-point scale, is predictive of surgical time or failure of same-day hospital disc harge. Study Design: Retrospective medical chart review of 103 patients having mas toidectomy with tympanoplasty for chronic otitis media over a 2-year period . Methods: We recorded patient age, clinical data, surgical times, types of a gents used for induction and maintenance of anesthesia, use of prophylactic antiemetic drugs, types and doses of analgesic agents, and PONV. Univariat e and multivariate logistic regression analyses were performed to determine which variables were associated with PONV that required hospital admission . Results: One third of patients studied were safely discharged from the hosp ital the day of surgery, and 92% were discharged within 23 hours. The most common cause for observation admission to the hospital was PONV. The only v ariable in multivariate analysis that significantly correlated with PONV ma ndating hospital admission after tympanomastoid surgery was a history of mo tion sickness or PONV (odds ratio, 5.21; P=.02). Although severity of disea se did not correlate with length of hospital stay, it directly correlated w ith length of surgery. Conclusions: A history of PONV or motion sickness is predictive of PONV and length of hospital stay. Routine planning for a 23-hour overnight observat ion stay seems warranted for all patients undergoing tympanomastoidectomy, despite severity of disease.