BACKGROUND Failure to discharge home after day-case procedures has a negative impact on patients, families, and hospital finances. There are currently no national paediatric data on the incidence and causes of unplanned admission. We determined the incidence of unplanned admissions after paediatric day-case anaesthesia, and identified risk factors leading to unplanned admission. METHODS During a 6 week period (in October and November 2017), all children aged 16 yr or under receiving general anaesthesia without an inpatient bed on arrival were included. Hospital, surgical, and procedural details; anonymised patient characteristic data; and anaesthetic and surgical experience were collected by local Paediatric Anaesthesia Trainee Research Network coordinators. A mixed-effects binary logistic regression model with backward selection was used to determine variables associated with unplanned admission. RESULTS Ninety three hospitals across the UK and Ireland participated. There were 25 986 cases, of which 640 were unplanned admissions. The independent risk factors for unplanned admission were ASA-physical status (PS) (ASA-PS 3/4 vs ASA-PS 1; odds ratio [OR]: 2.80 [95% confidence interval {CI}: 2.07-3.77]), duration of procedure (OR: 1.04 [95% CI: 1.03-1.05]), and surgical specialty (vs ear, nose, and throat [highest caseload specialty]: cardiology OR: 1.89 [95% CI: 1.15-3.06], orthopaedics/trauma OR: 0.91 [95% CI: 0.69-1.18], and general surgery OR: 0.59 [95% CI: 0.46-0.77]). The commonest reasons for admission were unexpected surgical complexity, pain, postoperative nausea and vomiting, and late finish. CONCLUSIONS Paediatric patient physical status, some types of surgery and duration of procedure were associated with unplanned day-surgery admissions. Unexpected surgical complexity and patient discomfort in recovery were common factors.

中文翻译：

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英国和爱尔兰儿科计划外日间住院的发生率：一项前瞻性多中心观察研究。


背景技术 日间手术后未能出院回家会对患者、家庭和医院财务产生负面影响。目前没有关于非计划入院的发生率和原因的全国儿科数据。我们确定了儿科日间麻醉后意外入院的发生率，并确定了导致意外入院的危险因素。方法 在 6 周期间（2017 年 10 月和 11 月），所有 16 岁或以下接受全身麻醉且抵达时没有住院床位的儿童均被纳入研究。医院、手术和程序细节；匿名患者特征数据；当地儿科麻醉实习生研究网络协调员收集了麻醉和手术经验。使用具有向后选择的混合效应二元逻辑回归模型来确定与计划外入院相关的变量。结果 英国和爱尔兰的 93 家医院参与其中。共有 25 986 例病例，其中 640 例为非计划入院。非计划入院的独立危险因素是 ASA 身体状况 (PS)（ASA-PS 3/4 与 ASA-PS 1；优势比 [OR]：2.80 [95% 置信区间 {CI}：2.07-3.77]），手术持续时间（OR：1.04 [95% CI：1.03-1.05]）和外科专业（与耳鼻喉科[病例数最多的专业]相比：心脏病学 OR：1.89 [95% CI：1.15-3.06]、骨科）创伤 OR：0.91 [95% CI：0.69-1.18]，普通手术 OR：0.59 [95% CI：0.46-0.77]）。入院最常见的原因是意外的手术复杂性、疼痛、术后恶心和呕吐以及延迟完成。结论 儿科患者的身体状况、某些类型的手术和手术持续时间与计划外日间手术入院有关。 意外的手术复杂性和患者康复过程中的不适是常见因素。