Acute complications in the post-anaesthesia care unit after infrainguinal surgery for lower limb ischaemia – a prospective observational cohort study

Abstract

Abstract. Background: Arterial surgery for lower limb ischaemia is a frequently performed procedure in patients with severe cardio-pulmonary comorbidities, making them high-risk patients for acute postoperative complications with a need for prolonged stay in the post-anaesthesia care unit (PACU). However, detailed information on complications during the PACU stay is limited, hindering mechanism-based interventions for early enhanced recovery. Thus, we aimed to systematically describe acute complications and related risk factors in the immediate postoperative phase after infrainguinal arterial surgery. Patients and methods: Patients transferred to the PACU after infrainguinal arterial surgery due to chronic or acute lower limb ischaemia were consecutively included in a six-month observational cohort study. Pre- and intraoperative data included comorbidities as well as surgical and anaesthetic technique. Data on complications and treatments in the PACU were collected every 15 minutes using a standardised assessment tool. The primary endpoint was occurrence of predefined moderate or severe complications occurring during PACU stay. Results: In total, 155 patients were included for analysis. Eighty (52 %) patients experienced episodes with oxygen desaturation (< 85 %) and moderate or severe pain occurred in 72 patients (47 %); however, circulatory complications (hypotension, tachycardia) were rare. Preoperative opioid use was a significant risk factor for moderate or severe pain in PACU (59 vs. 38 % chronic vs. opioid naïve patients (P = 0.01). Conclusions: Complications in the PACU after infrainguinal arterial surgery relates to saturation and pain, suggesting that future efforts should focus on anaesthesia and analgesic techniques including opioid sparing regimes to enhance early postoperative recovery.

Continuous wireless pre‐ and postoperative vital sign monitoring reveal new, severe desaturations after vascular surgery

“…Vascular surgery patients were chosen as they are characterised by a high occurrence of comorbidities, especially hypertension, ischemic and incompensated cardiac disease, diabetes, and moderate/severe Chronic Obstructive Pulmonary Disease(COPD) 10 . Interestingly, we found that despite vascular patients having a high proportion of cardiovascular comorbidities, circulatory abnormalities were less common than respiratory abnormalities, in agreement with other studies of vital values of similar patients 19 . We also find that for many of our thresholds, patients do not have long‐lasting sustained deviations as per our thresholds.…”

“…10 Interestingly, we found that despite vascular patients having a high proportion of cardiovascular comorbidities, circulatory abnormalities were less common than respiratory abnormalities, in agreement with other studies of vital values of similar patients. 19 We also find that for many of our thresholds, patients do not have long-lasting sustained deviations as per our thresholds. This is due to most events being short-lasting.…”

“…This threshold has previously been significantly linked to postoperative morbidity and 1‐year mortality 17 . Similar continuous monitoring studies have also used SpO 2 < 85% as a threshold for severe desaturation 17–19 . We did, however, find that cumulative duration of severe desaturations of SpO 2 < 80% duration is significantly longer postoperatively, indicating that this is indicative of a worsened physiological state.…”

“…17 Similar continuous monitoring studies have also used SpO 2 < 85% as a threshold for severe desaturation. [17][18][19] We did, however, find that cumulative duration of severe desaturations of SpO 2 < 80% duration is significantly longer postoperatively, indicating that this is indicative of a worsened physiological state. These episodes of severe prolonged desaturations, which do not seem to reflect preoperative physiology, 4 should be treated with proportional potency in the postoperative period.…”