Unplanned revisits and readmissions after ambulatory sinonasal surgery

Abstract

Objectives/hypothesis: Determine rates and reasons for revisits after adult ambulatory sinonasal surgery.

Study design: Cross-sectional analysis of multi-state ambulatory surgery and hospital databases.

Methods: Ambulatory adult sinonasal procedures were extracted from the State Ambulatory Surgery Databases for New York, Florida, Iowa, and California for 2010. Cases were linked to the State Emergency Department Databases and the State Inpatient Databases for visit encounters occurring 0 to 14 days after the procedure. The number of revisits (including readmissions) was determined as well as the reason for revisit. The overall rate of and intervention rate for postprocedural bleeding were determined.

Results: A total of 35,678 ambulatory sinonasal cases were extracted (mean age, 47.5 years). Overall, 5.0% of patients had a revisit after surgery (18.9% revisited the ambulatory surgery center, 67.0% the emergency department, and 14.1% to inpatient admission). The primary diagnoses at the first revisit were bleeding (23.0%), acute pain (3.7%), and fever/dehydration (3.8%). Overall, 0.8% of patients incurred a second revisit. Among all cases, 1.2% and 0.3% presented with a bleeding diagnosis at a first and second revisit, respectively. Among revisits, 1.0% and 17.9% underwent a procedure to control bleeding at the first and second revisits, respectively. Three deaths were noted for an overall 14-day mortality rate of 0.0084%.

Conclusion: There is a nonnegligible revisit rate after ambulatory sinonasal surgery. The most common reasons for revisit include bleeding, but also acute pain and fever/dehydration. These particular complications should be targeted for prevention to reduce postoperative revisit rates.

Keywords: Sinus surgery; complications; dehydration; postoperative hemorrhage; readmission; septoplasty.