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Factors influencing unexpected disposition after orthopedic ambulatory surgery
Open accessAbstract
Study objective To analyze whether patient characteristics, ambulatory facility type, anesthesia provider and technique, procedure type, and temporal factors impact the outcome of unexpected disposition after ambulatory knee and shoulder surgery.Design Retrospective analysis of a national database.Setting Freestanding and hospital-based ambulatory surgery facilities.Measurements Ambulatory knee and shoulder surgery cases from 1996 and 2006 were identified through the National Survey of Ambulatory Surgery. The incidence of unexpected disposition status was determined and risk factors for such outcome were analyzed.Main results Factors independently increasing the risk for unexpected disposition included procedures performed in hospital-based versus freestanding facilities [odds ratio (OR) 6.83 (95% confidence interval [CI] 4.34; 10.75)], shoulder versus knee procedures [OR 3.84 (CI 2.55; 5.77)], anesthesia provided by nonanesthesiology professionals and certified registered nurse-anesthetists versus anesthesiologists [OR 7.33 (CI 4.18; 12.84) and OR 1.80 (CI 1.09; 2.99), respectively]. Decreased risk for unexpected disposition was for procedures performed in 2006 versus 1996 [OR 0.15 (CI 0.10; 0.24)] and the use of anesthesia other than regional or general [OR 0.34 (CI 0.18; 0.68)].Conclusions The decreased risk for unexpected disposition associated with more recent data and with freestanding versus hospital-based facilities may represent improvements in efficiency, while the decreased odds for such disposition status associated with the use of other than general or regional anesthesia may be related to a lower invasiveness of cases. We found an increased risk of adverse disposition in cases where the anesthesia provider was a nonanesthesiology professional. No difference in this outcome was noted when an anesthesia care team provided care.
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CRNA-administered anesthetics for orthopedic ambulatory surgery were associated with increased odds of unexpected disposition when compared with anesthesiologist-administered anesthesia.
“Certified Registered Nurse Anesthetist-administered anesthetics for orthopedic ambulatory surgery was associated with increased odds of unexpected disposition when compared with anesthesiologist-administered anesthesia.99”
From The anesthesia human resources crisis in Canada (2024) · cites this paper as [99]
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Advocacy, Research, and Anesthesia Practice Models: Key Studies of Safety and Cost-Effectiveness
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Metadata
- Authors
- Memtsoudis, S. G., Ma, Y., Swamidoss, C. P., Edwards, A. M., Mazumdar, M., & Liguori, G. A.
- Affiliations
- Hospital for Special Surgery (US)
- Corresponding author
- Memtsoudis, Stavros G.
- Venue
- Journal of Clinical Anesthesia
- Publisher
- Elsevier BV
- Published
- 2012-03
- Volume
- 24
- Issue
- 2
- Pages
- 89-95
- ISSN
- 0952-8180 (ISSN-L)
- PMC
- PMC3303976
- OpenAlex
- W2109084451
- Cited by
- 38
- References
- 19
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 4 · 2022: 1 · 2021: 2 · 2020: 3 · 2019: 5 · 2018: 2 · 2017: 1 · 2016: 2 · 2015: 3 · 2014: 4 · 2013: 4 · 2012: 2
- FWCI
- 7.14
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Journal of Clinical Anesthesia (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Hospital for Special Surgery
- National Institutes of Health (RR024996)
- Agency for Healthcare Research and Quality (RFA-HS-05-14)
- National Center for Research Resources (UL1RR024996)
- Topics
- Social Sciences › Decision Sciences › Management Science and Operations Research › Healthcare Operations and Scheduling Optimization
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
- Keywords
- outpatient surgery, orthopedic surgery, knee surgery, shoulder surgery, certified registered nurse anesthetists, anesthesiologists, regional anesthesia, general anesthesia, anesthesia care team, temporal trends
- MeSH terms
- Adolescent, Adult, Aged, Ambulatory Care Facilities, Ambulatory Surgical Procedures, Anesthesia, Anesthesiology, Female, Humans, Knee Joint, Male, Middle Aged, Patient Discharge, Retrospective Studies, Risk Factors, Shoulder Joint, United States, Databases, Factual, Outcome Assessment, Health Care, Orthopedic Procedures, Young Adult
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