The association between unanticipated prolonged post-anaesthesia care unit length of stay and early postoperative deterioration: A retrospective cohort study

Abstract

This study aimed to investigate whether there was an association between an unanticipated prolonged post-anaesthesia care unit (PACU) length of stay and early postoperative deterioration, as defined as the need for a rapid response team activation, within the first seven days of surgery. We conducted a single-centre retrospective cohort study of adult surgical patients, who stayed at least one night in hospital, and were not admitted to critical care immediately postoperatively, between 1 July 2017 and 30 June 2019. A total of 11,885 cases were analysed. PACU length of stay was significantly associated with rapid response team activation on both univariate (odds ratio (OR) per increment 1.57, 95% confidence intervals (CI) 1.45 to 1.69, P < 0.001) and multivariate analysis (OR per increment 1.41, 95% CI 1.28 to 1.55, P < 0.001). Patients who stayed less than one hour were at low risk of deterioration (absolute risk 3.7%). In patients staying longer than one hour, the absolute increase in risk was small but observable within six hours of PACU discharge. Compar\ed to a one-hour length of stay, a five-hour stay had a relative risk of 4.9 (95% CI 3.7 to 6.1). Other factors associated with rapid response team activation included non-elective surgery (OR 1.78, P < 0.001) and theatre length of stay (OR per increment 1.61, P < 0.001). PACU length of stay was also independently associated with predefined complications and unplanned intensive care unit admission postoperatively. In our cohort, an unanticipated prolonged PACU length of stay of over one hour was associated with an increased incidence of rapid response team activation in the first seven days postoperatively.

Delayed discharge from post-anesthesia care unit: A 20-case retrospective series

“…Patients who involved such issues might experience longer PACU stays than those who did not, which is consistent with other studies. [ 8 , 15 , 16 ] Hypotension, hypoxia, tachycardia were the critical incidents. Kluger and Bullock also reported that the majority of recovery room incidents were cardiorespiratory related.…”

Construction of a nursing assessment framework for patients in anaesthesia recovery period: A modified Delphi study

“…Respiratory depression (Laporta et al, 2020), neurological events, including emergence agitation or delirium (Jin et al, 2020), post-operative nausea and vomiting (Schlesinger et al, 2023), abnormal temperature (Kim et al, 2019) and even cardiac arrest (Kaiser et al, 2020) might occur during this critical period. Unexpected adverse events during the anaesthesia recovery period might lead to early post-operative deterioration of the patient's health, possibly resulting in prolonged hospitalization or even death (Fletcher et al, 2022). Therefore, it is critically important for nurses to closely monitor patients who are recovering from anaesthesia.…”

Development and Validation of a Clinical Model for Predicting Delay in Postoperative Transfer Out of the Post-Anesthesia Care Unit: A Retrospective Cohort Study

“… 1 Delay in transferring the patient out of the PACU can result in a range of adverse consequences for the patient, such as increased postoperative complications, prolonged recovery time, and inefficient utilization of healthcare resources. 2 Given the escalating number of patients undergoing surgical procedures, 3 the PACU has become an important link in the continuum of care, responsible for the postoperative monitoring and treatment of patients, thereby under tremendous pressure due to the high patient turnover. However, the use of standardized assessment tools for PACU discharge can improve PACU turnover rates, reduce complications, and ensure postoperative patient safety.…”