Author(s)
Isabelle Gengler, MD, MS
Xavier Pasquesoone, MD
Laurent Carpentier, MD
Dominique Chevalier, MD,PhD
Geoffrey Mortuaire, MD, PhD
Affiliation(s)
Otorhinolaryngology - Head and Neck Surgery Department, University Hospital, Lil
Abstract:
Introduction: The objective is to identify predictive factors of readmission after day-case rhinologic surgery. As ambulatory surgery accounts for an ever-increasing share of surgical procedures, advances in endonasal surgical techniques and anesthetic management allows to perform more complex surgeries on higher-risk patients in a day-case setting. Our goal is to better target those patients whose treatment would be suitable for outpatient surgery.Methods: A 2-year retrospective chart review of patients scheduled for ambulatory sinonasal surgery under general anesthesia in a tertiary medical center was conducted. The operating room and the anesthetic files were screened to identify comorbidities, types of procedure and post-operative complications. The primary outcome of interest was unanticipated admission within 30 days of surgery.Results: From January 2014 to January 2016, 924 outpatient sinonasal procedures were performed. Functional endoscopic sinus surgery (FESS) with or without ethmoidectomy accounted for 53% of the cases. The overall readmission rate within the 30-postoperative days was 5.1% (2.9% for immediate hospitalization, 2.2% for unplanned post procedure visit to the hospital emergency room within 30 days of discharge) and was mainly due to bleeding (30%). Age above 50 years old, surgical duration of more than 80 minutes, endoscopic sinus surgery procedures and postoperative nasal packing were identified as significative negative predictive factors of readmission. Conclusion: Sinonasal surgery and FESS are safe when performed as outpatient procedures, with only few complications. Careful scheduling of those higher-risk patients undergoing sinonasal surgery and appropriate postoperative observation should be implemented to improve healthcare quality in an outpatient setting.