Continuous Analysis of Critical Incidents for 92,136 Postanesthesia Care Unit Patients of a Chinese University Hospital

Liu, Shangkun; Wang, Zhenxing; Xiong, Juan; Wan, Li; Luo, Ailin; Wang, Xueren

doi:10.1016/j.jopan.2020.03.015

Cited by 11 publications

(5 citation statements)

References 21 publications

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“…In this present study, 4(28.57%) and 10(71.43%) patients with RAP had ASA physical status III and II, respectively. RAP may occur in patients with relatively few comorbidities and in whom clinicians might not expect the occurrence of RAP, as reported previously 8, 19 .…”

Section: Discussionmentioning

confidence: 52%

Incidence and Outcome of Reintubation in the Postanesthesia Care Unit: a Single-center, Retrospective, Observational Matched Cohort Study in China

Liu

Dong

Wan

et al. 2021

Preprint

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Backgroundː Reintubation after planned extubation (RAP) is a serious adverse event. This study aimed to determine the rate and impact of RAP on postoperative course and hospitalization outcomes.Methodsː Of the 121,965 patients in the PACU, 14 patients with RAP were included in this retrospective, single-center, 1:2 matched cohort study in China from January 1, 2017 to December 31, 2019. Duration of PACU stay, postoperative time in the hospital, inpatient healthcare costs, and outcome of hospitalization were compared between the RAP and matched groups.Resultsː The rate of RAP occurrence was 0.0115%. After propensity score matching, there were no statistically significant differences in age, sex, body mass index, emergency operation, surgical classification, American Society of Anesthesiologists physical status, and the durations of anesthesia and the procedure between the two groups. Duration of PACU stay, length of postoperative stay, and inpatient healthcare costs significantly differed between the RAP and matched groups (P < 0.01 for all). The percentage of patients in whom discharge from the PACU was prolonged was significantly higher in the RAP group than in the matched group (92.86% vs.714%), with an odds ratio of 29.87 (95% CI = 14.00 to 2040.54; P < 0.001) after matching.Conclusionsː RAP in the PACU had low incidence but was associated with life-threatening and serious complications, increased incidence of prolonged discharge, prolonged PACU and postoperative hospital stay, increased inpatient healthcare costs, and unanticipated intensive care unit admission. Hypoxemia, airway obstruction, dyspnea, respiratory depression, confusion, asthma, chest tightness, pain, hemorrhage, or agitation could be the risk factor for RAP. The appropriate time for tracheal extubation and monitoring in PACU can effectively prevent the occurrence of reintubation and improve the prognosis of patients.

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Section: Discussionmentioning

confidence: 52%

Incidence and Outcome of Reintubation in the Postanesthesia Care Unit: a Single-center, Retrospective, Observational Matched Cohort Study in China

Liu

Dong

Wan

et al. 2021

Preprint

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“…Previous studies have shown that approximately 7.3–26.9% of patients in the post anaesthesia care unit (PACU) experience pain [ 4 , 5 ]. The incidence of moderate-to-severe pain in the PACU was 1.42% in our study.…”

Section: Discussionmentioning

confidence: 99%

“…According to an American survey study, 86% of patients experience pain after surgery, and 75% experience moderate-to-severe pain immediately after surgery [ 3 ]. Previous studies have shown that approximately 7.3–26.9% of patients in the post anaesthesia care unit (PACU) experience pain [ 4 , 5 ]. Although we use local anaesthetics, opioids, cyclooxygenase inhibitors, derivatives of herbal preparations, and physical intervention to prevent and treat postoperative pain, acute postoperative pain remains a major clinical problem [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Predictors and influence of postoperative moderate-to-severe pain of PACU in the patients with malignancy

Zhang,

Dai,

et al. 2024

BMC Anesthesiol

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Background This study was identified the risk factors for and designed to investigate influence of postoperative moderate-to-severe pain of post anaesthesia care unit (PACU) in patients with malignancy. Methods A retrospective study was performed on 22,600 cancer patients with malignancy who underwent elective radical surgery in the new hospital of First Affiliated Hospital of Wenzhou Medical University, between January 2016 and June 2021. All patients were transferred to the PACU after tracheal extubation. Patients were divided into two groups according to a visual analogue scale (VAS) score of > 3: the no-moderate-severe-pain group and moderate-to-severe-pain group. Data pertaining to demographic, surgical, anaesthetic, and other factors were recorded. Lasso and logistic regression analysis was performed to explore the risk factors, then a nomogram was constructed to predict the moderate-severe-pain in the PACU. Validation was performed by using another 662 cancer patients in old hospital. The ROC curves and calibration curve were used to evaluate the accuracy and predictive ability of the nomogram. Results The incidence of postoperative moderate-to-severe pain of PACU in patients with malignancy was 1.42%. Gender, type of surgery, postoperative use of PCA, intraoperative adjuvant opioid agonists, NSAIDS, epidural analgesia, duration of anaesthesia, intraoperative massive haemorrhage, PACU vomiting were independent predictors for postoperative moderate-to-severe pain of PACU in the patients with malignancy. The area under the ROC curve of the predictive models in the primary and validation groups were 0.817 and 0.786, respectively. Moderate-to-severe pain in the PACU correlated with hypertension, hyperglycaemia, agitation, and hypoxemia (P < 0.05). Conclusions The prediction model for postoperative moderate-to-severe pain of PACU in patients with malignancy has good predictive ability and high accuracy, which is helpful for PACU medical staff to identify and prevent postoperative moderate-to-severe pain in advance. Trial registration The study was approved by the Clinical Research Ethics Committee of the First Affiliated Hospital of Wenzhou Medical University (No.KY2021-097) and registered in the Chictr.org.cn registration system on 06/12/2021 (ChiCTR2100054013).

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“…In a large-scale retrospective study involving 92,136 surgical patients focusing on critical incidents including moderate-to-severe pain (i.e., NRS > 3) and immediate complications in the PACU, the incidence of moderate-to-severe pain was 26.9%, which accounted for almost one-third of all patients in that study [ 32 ]. Moreover, another study reported moderate-to-extreme pain in up to 64% of inpatients before hospital discharge [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

Elevated Surgical Pleth Index at the End of Surgery Is Associated with Postoperative Moderate-to-Severe Pain: A Systematic Review and Meta-Analysis

et al. 2022

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Despite acceptance of the surgical pleth index (SPI) for monitoring the intraoperative balance between noxious stimulation and anti-nociception under general anesthesia, its efficacy for predicting postoperative moderate-to-severe pain remains unclear. We searched electronic databases (e.g., Google Scholar, MEDLINE, Cochrane Library, and EMBASE) to identify articles focusing on associations of SPI at the end of surgery with immediate moderate-to-severe pain in the postanesthesia care unit from inception to 7 July 2022. A total of six observational studies involving 756 adults published between 2016 and 2020 were eligible for quantitative syntheses. Pooled results revealed higher values of SPI in patients with moderate-to-severe pain than those without (mean difference: 7.82, 95% CI: 3.69 to 11.95, p = 0.002, I2 = 46%). In addition, an elevated SPI at the end of surgery was able to predict moderate-to-severe pain with a sensitivity of 0.71 (95% confidence interval (CI): 0.65–0.77; I2 = 29.01%) and a specificity of 0.58 (95% CI: 0.39–0.74; I2 = 79.31%). The overall accuracy based on the summary receiver operating characteristic (sROC) curve was 0.72. In conclusion, this meta-analysis highlighted the feasibility of the surgical pleth index to predict postoperative moderate-to-severe pain immediately after surgery. Our results from a limited number of studies warrant further investigations for verification.

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Continuous Analysis of Critical Incidents for 92,136 Postanesthesia Care Unit Patients of a Chinese University Hospital

Cited by 11 publications

References 21 publications

Incidence and Outcome of Reintubation in the Postanesthesia Care Unit: a Single-center, Retrospective, Observational Matched Cohort Study in China

Incidence and Outcome of Reintubation in the Postanesthesia Care Unit: a Single-center, Retrospective, Observational Matched Cohort Study in China

Predictors and influence of postoperative moderate-to-severe pain of PACU in the patients with malignancy

Elevated Surgical Pleth Index at the End of Surgery Is Associated with Postoperative Moderate-to-Severe Pain: A Systematic Review and Meta-Analysis

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