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Adverse events in ambulatory surgery. A comparison between elderly and younger patients

  • Frances Chung
  • Gabor Mezei
  • Doris Tong
Reports of Investigation

Abstract

Purpose

An increasing number of elderly patients are undergoing ambulatory surgery. We examined whether ambulatory surgery carries a higher risk for the elderly than for younger patients.

Methods

A total of 17,638 consecutive ambulatory surgical patients were enrolled in a prospective cohort study during a three-year period. Preoperative, intraoperative, and postoperative information was collected. Twentyseven percent of the enrolled patients were 65 yr or older. Incidence rates of intraoperative and postoperative adverse events among the elderly were compared with those among younger patients; we controlled for sex, ASA physical status, body mass index, type of surgery, and duration of procedure, using multiple logistic regression models.

Results

Elderly patients had a higher incidence of any intraoperative event (adjusted odds ratio, 1.4; 99.7% confidence interval [CI], 1.0–2.0) and of intraoperative cardiovascular events (adjusted odds ratio, 2.0; 99.7% CI, 1.3–3.0). They also had a lower incidence of any postoperative event (adjusted odds ratio, 0.4; 99.7% CI, 0.3–0.6) and of postoperative pain (adjusted odds ratio, 0.2; 99.7% CI, 0.1–0.4), nausea and vomiting (adjusted odds ratio, 0.3; 99.7% CI, 0.1–0.6), and dizziness (adjusted odds ratio, 0.4; 99.7% CI, 0.2–1.0).

Conclusion

The risks reported do not constitute a contraindication for elderly patients to undergo ambulatory surgery but this population may require more careful intraoperative cardiovascular management.

Keywords

Operating Room Adjusted Odds Ratio Malignant Hyperthermia Postoperative Event Postoperative Adverse Event 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Objectif

Un nombre croissant de patients âgés se retrouvent en chirurgie ambulatoire. Nous avons chercher à savoir si la chirurgie ambulatoire comporte un plus grand risque pour les gens âgés comparés aux jeunes patients.

Méthode

Ce sont 17 638 patients qui se sont présentés successivement en chirurgie ambulatoire qui ont été recrutés pour une étude comparative des cohortes qui a duré trois ans. On a recueilli les renseignements préopératoires, peropératoires et postopératoires nécessaires. Parmi les patients choisis, 27% avaient 65 ans ou plus. On a comparé l’incidence des effets secondaires peropératoires et postopératoires entre les patients âgés et les jeunes patients selon le sexe, l’état physique ASA, l’indice de masse corporelle, le type de chirurgie et la durée de l’opération, en utilisant des modèles de régression logistique multiple.

Résultats

Les patients âgés présentaient une plus forte incidence de tout événement peropératoire (coefficient de risque ajusté, 1,4; intervalle de confiance de 99,7% [IC], 1,0 – 2,0) et d’incidents cardiovasculaires peropératoires (CR ajusté, 2,0; IC de 99,7%, 1,3 – 3,0). Ils présentaient, par ailleurs, une plus faible incidence de tout événement postopératoire (CR ajusté, 0,4; IC de 99,7%, 0,3 – 0,6) et de douleur (CR ajusté, 0,2; IC de 99,7%, 0,1 – 0,4), de nausées et de vomissements (CR ajusté, 0,3; IC de 99,7%, 0,1 – 0,6), et d’étourdissement postopératoires (CR ajusté, 0,4; IC de 99,7%, 0,2 – 1,0).

Conclusion

Les risques rapportés ne constituent pas une contre-indication à la chirurgie ambulatoire pour les gens âgés, mais cette population demande qu’on soit plus attentif aux risques cardiovasculaires peropératoires.

References

  1. 1.
    White PF. Ambulatory anesthesia and surgery: past, present and future. In: White PF (Ed.). Ambulatory Anesthesia and Surgery. London: WB Saunders, 1997: 3–34.Google Scholar
  2. 2.
    Korttila K. Recovery from outpatient anaesthesia. Factors affecting outcome. Anaesthesia 1995; 50 (Suppl): 22–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Henderson JA. Ambulatory surgery: past, present, and future. In: Wetchler BV (Ed.). Anesthesia for Ambulatory Surgery. Philadelphia: Lippincott Co., 1991: 1–27.Google Scholar
  4. 4.
    Weintraub HD, Kekoler LJ. Demographics of aging. In: McLeskey CH (Ed.). Geriatric Anesthesiology. Baltimore: Williams and Wilkins, 1997: 3–11.Google Scholar
  5. 5.
    Bouré B, White PF. Outpatient anesthesia for geriatric patients. In: McLeskey CH (Ed.). Geriatric Anesthesiology. Baltimore: Williams and Wilkins, 1997: 441–57.Google Scholar
  6. 6.
    Warner MA, Hosking MP, Lobdell CM, Offord KP, Melton LJ III. Surgical procedures among those ≥90 years of age. Ann Surg 1988; 207: 380–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Lagoe RJ, Bice SE, Abulencia PB. Ambulatory surgery utilization by age level. Am J Public Health 1987; 77: 33–7.PubMedGoogle Scholar
  8. 8.
    Natof HE. Complications associated with ambulatory surgery. JAMA 1980; 244: 1116–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Pedersen T, Eliasen K, Henriksen E. A prospective study of mortality associated with anaesthesia and surgery: risk indicators of mortality in hospital. Acta Anaesthesiol Scand 1990; 34: 176–82.PubMedGoogle Scholar
  10. 10.
    Warner MA, Shields SE, Chute CG. Major morbidity and mortality within 1 month of ambulatory surgery and anesthesia. JAMA 1993; 270: 1437–41.PubMedCrossRefGoogle Scholar
  11. 11.
    Cohen MM, Duncan PG, Tate RB. Does anesthesia contribute to operative mortality? JAMA 1988; 260: 2859–63.PubMedCrossRefGoogle Scholar
  12. 12.
    Fortier J, Chung F, Su J. Unanticipated admission after ambulatory surgery — a prospective study. Can J Anaesth 1998; 45: 612–9.PubMedGoogle Scholar
  13. 13.
    Fancourt-Smith PF, Hornstein J, Jenkins LC. Hospital admissions from the Surgical Day Care Centre of Vancouver General Hospital 1977–1987. Can J Anaesth 1990; 37: 699–704.PubMedGoogle Scholar
  14. 14.
    Gold BS, Kitz DS, Lecky JH, Neuhaus JM. Unanticipated admission to the hospital following ambulatory surgery. JAMA 1989; 262: 3008–10.PubMedCrossRefGoogle Scholar
  15. 15.
    Tong D, Chung F, Wong D. Predictive factors in global and anesthesia satisfaction in ambulatory surgical patients. Anesthesiology 1997; 87: 856–64.PubMedCrossRefGoogle Scholar
  16. 16.
    Duncan PG, Cohen MM, Tweed WA, et al. The Canadian four-centre study of anaesthetic outcomes: III. Are anaesthetic complications predictable in day surgical practice? Can J Anaesth 1992; 39: 440–8.PubMedGoogle Scholar
  17. 17.
    Heino A, Vainio J, Turunen M, Lahtinen J. Results of 500 general surgery patients operated on in the ambulatory surgery unit. Ann Chirurg Gynaecol 1992; 81: 295–9.Google Scholar
  18. 18.
    Chung F. Are discharge criteria changing? J Clin Anesth 1993; 5: 64S-8.PubMedCrossRefGoogle Scholar
  19. 19.
    Chung F. Discharge criteria — a new trend. Can J Anaesth 1995; 42: 1056–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Osborne GA, Rudkin GE. Outcome after day-care surgery in a major teaching hospital. Anaesth Intensive Care 1993; 21: 822–7.PubMedGoogle Scholar
  21. 21.
    Meridy HW. Criteria for selection of ambulatory surgical patients and guidelines for anesthetic management: a retrospective study of 1553 cases. Anesth Analg 1982; 61: 921–6.PubMedCrossRefGoogle Scholar

Copyright information

© Canadian Anesthesiologists 1999

Authors and Affiliations

  1. 1.Department of AnaesthesiaToronto Western Hospital, University of TorontoTorontoCanada

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