1. Hospitalisation vs Day Surgery for elective middle ear surgery: results of a local retrospective chart review and national survey
Tanja Jelicic, Dr Maggie Aron and Dr Julian Savage
Division d’ORL, Université de Sherbrooke
Introduction
Is it truly necessary to hospitalise patients after elective middle ear surgery or is day surgery a viable option for these cases? Surprisingly, there is no Canadian consensus and it would seem that decision making is more related to the individual surgeon’s experience and comfort with letting patients leave hospital on the same day of surgery.
Hospitalization Group
N: 197
No facial palsy identified
Patients discharged post-op day 1: 91.4%
The primary reason for prolonged hospital stay (i.e. longer than one postop night stay) was nausea/vertigo, accounting for 72% of all prolonged admissions
Revision stapes surgery accounted for the commonest surgery associated with postoperative dizziness (p=0.048) requiring a prolonged stay (p=0.041)
Results of chart review
Day Surgery Group
N: 240
4% of all patients operated required an overnight hospital stay (commonest reasons were nausea and vomiting)
Emergency room visits in the first 48h after surgery: 2.9%
Readmission rate: 1.3%
Commonest reasons for readmission were nausea (57%) and vertigo (67%).
The commonest procedure leading to representation in emergency was stapes surgery, although this was not significant (p>0.05)
Advantages of Hospitalization
Identification of early complications
Avoid readmissions
Controlled bed rest in immediate postoperative period
Advantages of
Day Surgery
Reduction in cost to hospital per individual case
Increased bed availability for other patients
Less hospital acquired complications
National Survey results
Study objectives / Methods
After elective middle ear surgery is…
Hospitalization necessary ?
File review of any postoperative complications during hospital stay
Day surgery a safe option for these patients?
File review of any emergency consultations or readmissions in 48 hour post-operative period
What is the standard of practice and experience of the Canadian ENT community?
National Survey via CSOHNS
4 x 8 pieds
If planned routinely as day cases, what factors might change your practice?
Tympanoplasty
Routinely planned as….
Post-operative hospitalization
Day case surgery
Stapes Surgery
Patient factors (75%): SHAS, ATC, co-morbidities
Disease factors (15%): revision
Social factors (50%): lack over-night co-habitor
None (10%)
Tympanomastoidectomy
Post-operative hospitalization
Day case surgery
Tympanoplasty & Tympanomastoidectomy
Patient factors (80%): SHAS, age
Disease factors (30%): LSCC fistula, revision, planned surgical time
Social factors (50%): lack over-night co-habitor
None (13%)
Hypothesis
We hypothesize that there is little need for overnight hospital admission in the majority of our otological cases. This comes from anecdotal experience of patients not needing any medical input from the ENT team in the immediate postoperative period
Stapes surgery
Post-operative hospitalization
Day case surgery
Conclusions
Overall, most middle ear surgery can be relatively safely performed as a day case. This is from our observation that very few complications occurred within the period of hospitalization in our study
The only surgical procedure that had a significant prolonged hospital stay in our population was Revision Stapes Surgery. Overnight hospital stay should be considered if undertaking this surgery
Performing middle ear surgery as a day case has a positive impact on the hospital both economically and also bed availability for patients with greater need
Not performing stapes surgery
Hi! We’re not visitors, we’re just waiting for your bed..
Qualitative arguments from respondents for hospitalization…
“Simply to manage potential vertigo and nausea - both aggravated by movement if discharged too early.”
“Easier to have a bed booked than to try to find a bed for the patient experiencing difficulties"