Predictors of Unplanned Admission After Outpatient Rhytidectomy

Background Rhytidectomy is increasingly performed in ambulatory settings with the goal of a same-day discharge. A subset of patients requires unplanned admission in the immediate postoperative period, resulting in increased costs and workflow disruption. Identifying predictors of unplanned admission may improve perioperative planning. Objectives To determine risk factors for unplanned admission following rhytidectomy. Methods Retrospective review of patients undergoing rhytidectomy at a tertiary care center between June 2022 and July 2025. Demographics, comorbidities, surgical characteristics, and anesthetic details were compared between patients with same-day discharge and unplanned admission. Results Of 129 patients scheduled for outpatient rhytidectomy, 108 (83.7%) were discharged the same day and 21 (16.3%) required unplanned admission. Admission was associated with longer anesthesia duration (574.6 ± 102.4 vs. 485.7 ± 80.1 min, p = 0.001), greater number of concurrent procedures (mean 4.3 vs. 3.3 concurrent procedures, p = 0.002), obesity (BMI ≥30, p = 0.024), higher ASA class (p = 0.048), and hypertension (p = 0.016). Dexmedetomidine (p = 0.016) and hydromorphone (p = 0.034) were associated with unplanned admission, whereas remifentanil was associated with same-day discharge (p = 0.010). Conclusions Unplanned admission was associated with longer anesthesia duration, greater number of concurrent procedures, select anesthetic agents, and comorbidities. Incorporating these factors into perioperative planning may improve discharge predictability and resource allocation.