Although demographic characteristics and comorbidities have been included in prediction models as risk factors for a prolonged hospital stay, factors linked to anesthetic management in ambulatory surgery have yet to be identified. For a study, researchers sought to discover anesthetic parameters related to a longer discharge time after ambulatory surgery.
All clinical data of patients who had ambulatory cholecystectomy between January 1st, 2012, and December 31st, 2018, at a French University Hospital (Hôpital Saint Antoine, Paris) were reviewed retrospectively. The primary endpoint was the time between the end of surgery and discharge, defined as the time between the conclusion and discharge. A multivariable Cox proportional-hazards model was built to evaluate the variables associated with a prolonged discharge time.
There were 535 patients in all. The median time for discharge was 150 minutes (interquartile range – IQR [129-192]). A bivariable analysis revealed a favorable relationship between the discharge timing and the dose-weight of ketamine and sufentanil. The anesthesia-related factors independently associated with prolonged discharge time in the multivariable Cox proportional hazards model analysis were the dose-weight of ketamine in interaction with the dose weight of sufentanil (HR 0.10 per increment of 0.1 mg/kg of ketamine or 0.2 μg/kg of sufentanil, CI 95 % [0.01-0.61], P=0.013) and the non-use of a non-steroidal anti-inflammatory drug (NSAID) (HR 0.81 [0.67–0.98], P=0.034). Following surgery, 20 patients (4%) required unplanned hospitalization.
Anesthesia management, including the use of ketamine and the avoidance of NSAIDs, impacts the time to hospital discharge.