Analysis of patients planned for admission after dental treatment under general anesthesia.

Abstract

Purpose: To describe patients pre-planned for admission to hospital after dental treatment under general anesthesia (GA) and compare those who were subsequently admitted to a medical hospitalist to those discharged shortly after surgical completion. Methods: Retrospective cohort study with review of electronic health records for patients planned for admission after dental treatment under GA between January 2015 and June 2017. Patients were excluded if the procedure was combined with another hospital service. Results: Of the 156 children pre-planned for admission, 97 (62%) were subsequently admitted. Characteristics of children associated with postoperative hospital admission include chromosomal anomalies (p=0.03), trisomy 21 (p<0.01), and a trend towards patients with obstructive sleep apnea (OSA) not compliant with continuous positive airway pressure (CPAP) (p=0.06), and a rating of American Society of Anesthesiologists (ASA) class III (p=0.07). Airway concern was the most common reason for planned admission (n=115; 74%) and the most common reason for subsequent admission (n=72; 46%). Children planned for admission for reasons of analgesia, nutrition or hydration were associated with admission (p<0.01). Apnea Hypopnea Index (AHI) was reported for 48 children and was not associated with admission. Body Mass Index (BMI) was not associated with admission. Significant differences in medical support provided to admitted patients versus discharged patients were: non-opiate analgesics (p<0.01), opiate analgesics (p=0.02), antiemetic (p=0.01), oxygen or airway support beyond typical post-operative care (p=0.05) and IV hydration (p<0.01). Conclusion: Expected postoperative sequelae should be discussed with caregivers, including potential need for oxygen, IV hydration, nutrition, antiemetics and analgesics postoperatively prior to assigning a patient to a surgical venue or planning for hospital admission after dental surgery. Children with a high BMI may not necessarily require postoperative hospital admission.