Gregory L. Barinsky, PharmD
Christina H. Fang, MD
Jordon G. Grube, DO
Wayne D. Hsueh, MD
Richard C. Park, MD
Jean Anderson Eloy, MD FACS
Rutgers New Jersey Medical School; Albany Medical Center
Educational Objective: At the conclusion of this presentation, the participants should be able to describe factors that may be associated with an increased risk of unplanned admission following elective outpatient endoscopic sinus surgery.
Objectives: To identify factors that may increase the risk of unplanned admission following elective outpatient endoscopic sinus surgery (ESS).
Study Design: Retrospective analysis of the National Surgical Quality Improvement Program (NSQIP).
Methods: All cases of ESS were extracted from the 2010-2018 NSQIP database using current procedural terminology codes. Only cases that were coded as outpatient, elective, and nonemergent procedures were included. Unplanned admissions were defined as cases with a total hospital stay of greater than 0 days. Univariate and multivariate analysis was performed to identify variables that independently predicted unanticipated admission.
Results: A total of 971 cases met inclusion criteria, of which 274 (28.2%) were unanticipated admissions. Patients in the unplanned admission group were more likely to be older (46.8 vs 41.1 years, p<0.001), male (57.7% vs 48.4%, p=0.009), obese (54.8% vs 43.8%, p=0.003), and hypertensive (35.0% vs 25.0%, p=0.002). Admitted patients were also more likely to be ASA classification III-IV (43.1% vs 27.2%, p<0.001). There were no significant differences in race, smoking, diabetes, or chronic steroid use. Admitted patients had a higher rate of surgical complications (2.9% vs 1.0%, p=0.041). Upon multivariate analysis, independent preoperative risk factors for unplanned admission included age (OR: 1.018, p=0.002), male gender (OR: 1.415, p=0.025), obesity (OR: 1.527, p=0.008), and ASA III-IV (OR 1.501, p=0.018).
Conclusions: Factors independently associated with unplanned admission following outpatient ESS were older age, male gender, obesity, and higher ASA classification. Preoperative identification of patients at risk may help reduce the burden of unanticipated hospital admission after ESS.