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"