Incidence of paediatric unplanned day-case admissions in the UK and Ireland: a prospective multicentre observational study

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.