Does perioperative respiratory event increase length of hospital stay and hospital cost in pediatric ambulatory surgery?

<h4>Objective</h4>We examined the consequences of perioperative respiratory event (PRE) in terms of hospitalization and hospital cost in children who underwent ambulatory surgery.<h4>Methods</h4>This subgroup analysis of a prospective cohort study (ClinicalTrials.gov: NCT0203...

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Autores principales:	Maliwan Oofuvong, Alan Frederick Geater, Virasakdi Chongsuvivatwong, Thavat Chanchayanon, Bussarin Sriyanaluk, Boonthida Suwanrat, Kanjana Nuanjun
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/2c4cde4ab6bd4edcadcfdddca620c4f7
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spelling	oai:doaj.org-article:2c4cde4ab6bd4edcadcfdddca620c4f72021-12-02T20:04:04ZDoes perioperative respiratory event increase length of hospital stay and hospital cost in pediatric ambulatory surgery?1932-620310.1371/journal.pone.0251433https://doaj.org/article/2c4cde4ab6bd4edcadcfdddca620c4f72021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0251433https://doaj.org/toc/1932-6203<h4>Objective</h4>We examined the consequences of perioperative respiratory event (PRE) in terms of hospitalization and hospital cost in children who underwent ambulatory surgery.<h4>Methods</h4>This subgroup analysis of a prospective cohort study (ClinicalTrials.gov: NCT02036021) was conducted in children aged between 1 month and 14 years who underwent ambulatory surgery between November 2012 and December 2013. Exposure was the presence of PRE either intraoperatively or in the postanesthetic care unit or both. The primary outcome was length of stay after surgery. The secondary outcome was excess hospital cost excluding surgical cost. Financial information was also compared between PRE and non-PRE. Directed acyclic graphs were used to select the covariates to be included in the multivariate regression models. The predictors of length of stay and excess hospital cost between PRE and non-PRE children are presented as adjusted odds ratio (OR) and cost ratio (CR), respectively with 95% confidence interval (CI).<h4>Results</h4>Sixty-three PRE and 249 non-PRE patients were recruited. In the univariate analysis, PRE was associated with length of stay (p = 0.004), postoperative oxygen requirement (p <0.001), and increased hospital charge (p = 0.006). After adjustments for age, history of snoring, American Society of Anesthesiologists physical status, type of surgery and type of payment, preoperative planned admission had an effect modification with PRE (p <0.001). The occurrence of PRE in the preoperative unplanned admission was associated with 24-fold increased odds of prolonged hospital stay (p <0.001). PRE was associated with higher excess hospital cost (CR = 1.35, p = 0.001). The mean differences in contribution margin for total procedure (per patient) (PRE vs non-PRE) differed significantly (mean = 1,523; 95% CI: 387, 2,658 baht).<h4>Conclusion</h4>PRE with unplanned admission was significantly associated with prolonged length of stay whereas PRE regardless of unplanned admission increased hospital cost by 35% in pediatric ambulatory surgery.<h4>Trial registration</h4>ClinicalTrials.gov registration number NCT02036021.Maliwan OofuvongAlan Frederick GeaterVirasakdi ChongsuvivatwongThavat ChanchayanonBussarin SriyanalukBoonthida SuwanratKanjana NuanjunPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 5, p e0251433 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Maliwan Oofuvong Alan Frederick Geater Virasakdi Chongsuvivatwong Thavat Chanchayanon Bussarin Sriyanaluk Boonthida Suwanrat Kanjana Nuanjun Does perioperative respiratory event increase length of hospital stay and hospital cost in pediatric ambulatory surgery?
description	<h4>Objective</h4>We examined the consequences of perioperative respiratory event (PRE) in terms of hospitalization and hospital cost in children who underwent ambulatory surgery.<h4>Methods</h4>This subgroup analysis of a prospective cohort study (ClinicalTrials.gov: NCT02036021) was conducted in children aged between 1 month and 14 years who underwent ambulatory surgery between November 2012 and December 2013. Exposure was the presence of PRE either intraoperatively or in the postanesthetic care unit or both. The primary outcome was length of stay after surgery. The secondary outcome was excess hospital cost excluding surgical cost. Financial information was also compared between PRE and non-PRE. Directed acyclic graphs were used to select the covariates to be included in the multivariate regression models. The predictors of length of stay and excess hospital cost between PRE and non-PRE children are presented as adjusted odds ratio (OR) and cost ratio (CR), respectively with 95% confidence interval (CI).<h4>Results</h4>Sixty-three PRE and 249 non-PRE patients were recruited. In the univariate analysis, PRE was associated with length of stay (p = 0.004), postoperative oxygen requirement (p <0.001), and increased hospital charge (p = 0.006). After adjustments for age, history of snoring, American Society of Anesthesiologists physical status, type of surgery and type of payment, preoperative planned admission had an effect modification with PRE (p <0.001). The occurrence of PRE in the preoperative unplanned admission was associated with 24-fold increased odds of prolonged hospital stay (p <0.001). PRE was associated with higher excess hospital cost (CR = 1.35, p = 0.001). The mean differences in contribution margin for total procedure (per patient) (PRE vs non-PRE) differed significantly (mean = 1,523; 95% CI: 387, 2,658 baht).<h4>Conclusion</h4>PRE with unplanned admission was significantly associated with prolonged length of stay whereas PRE regardless of unplanned admission increased hospital cost by 35% in pediatric ambulatory surgery.<h4>Trial registration</h4>ClinicalTrials.gov registration number NCT02036021.
format	article
author	Maliwan Oofuvong Alan Frederick Geater Virasakdi Chongsuvivatwong Thavat Chanchayanon Bussarin Sriyanaluk Boonthida Suwanrat Kanjana Nuanjun
author_facet	Maliwan Oofuvong Alan Frederick Geater Virasakdi Chongsuvivatwong Thavat Chanchayanon Bussarin Sriyanaluk Boonthida Suwanrat Kanjana Nuanjun
author_sort	Maliwan Oofuvong
title	Does perioperative respiratory event increase length of hospital stay and hospital cost in pediatric ambulatory surgery?
title_short	Does perioperative respiratory event increase length of hospital stay and hospital cost in pediatric ambulatory surgery?
title_full	Does perioperative respiratory event increase length of hospital stay and hospital cost in pediatric ambulatory surgery?
title_fullStr	Does perioperative respiratory event increase length of hospital stay and hospital cost in pediatric ambulatory surgery?
title_full_unstemmed	Does perioperative respiratory event increase length of hospital stay and hospital cost in pediatric ambulatory surgery?
title_sort	does perioperative respiratory event increase length of hospital stay and hospital cost in pediatric ambulatory surgery?
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/2c4cde4ab6bd4edcadcfdddca620c4f7
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Does perioperative respiratory event increase length of hospital stay and hospital cost in pediatric ambulatory surgery?

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