Magnitude of early postoperative hypoxemia and its associated factors among adult patients who undergo emergency surgery under general anesthesia at Jimma Medical Center, Jimma, Southwest Ethiopia, 2021: a prospective observational study

Abstract

Purpose Emergency surgical procedures involve considerable risks. Among these, early postoperative hypoxemia (EPH) is a frequent anesthetic complication in the post-anesthetic care unit (PACU). There is a great concern for EPH among health professionals, specifically, those providing emergency surgery during the nighttime. This raised anesthesia-ended time-related risk of EPH question. Thus, this study aimed to determine the magnitude of EPH and its associated factors among adult patients who undergo emergency surgery under general anesthesia. Methods A prospective observational study through a consecutive sampling technique was conducted. Binary logistic regression analysis was used to identify associated risk factors. All variables that were found statistically significant on bivariable analysis were entered into a multivariable logistic regression analysis. Result Of 352 patients who had undergone emergency surgery, 149 (42.3%) patients developed EPH. Factors significantly associated with EPH were anesthesia ended during nighttime (AOR = 1.76, 95%CI [1.01, 3.05], p = 0.045), ASA III (AOR = 12.35, 95%CI: [4.5, 34.02], p ≤ 0.001), age greater than 55 (AOR = 3.2, 95%CI: [1.7, 5.91], p ≤ 0.001), surgery duration greater than 2 h (AOR = 2.012, 95%CI: [1.2, 3.51], p = 0.014), hypotension (AOR = 10.3, 95%CI: [2.4, 44.16], p = 0.002), muscular strength score zero (AOR = 2.944, 95%CI: [1.8, 4.82], p ≤ 0.001), and preoperative oxygen saturation less than 95% (AOR = 2.371, 95%CI: [1.35,4.16], p = 0.003). Conclusion The magnitude of EPH among patients who have undergone emergency surgery was high and thus recommended that oxygen should be provided timely to decrease it. Identified risk factors were night-time ended anesthesia, ASA III, age greater than 55, surgery duration greater than 2 h, hypotension, muscular strength score zero, and preoperative oxygen saturation less than 95%. This study found anesthesia ended during early morning favors early morning early postoperative hypoxemia (EMEPH). To avert EMEPH, the anesthetist should avoid factors that favor the circadian rhythm of the lung-based early morning anesthesia augmented EPH.

Incidence and Predictors of Post-operative Hypoxemia in Pediatric Patients Undergoing General Anesthesia: a Single-arm Prospective Multi-center Cohort Study 2023

“…Pediatric patients who underwent above-abdominal surgeries were signi cantly associated with POH (p < 0.001) and an AOR of 3.642 ( (37). Even though there is a difference in study participants and the operational de nition of prolonged operation time, both studies had comparable study results to ours.…”

“…Taye et al (2021) on predictors of hypoxemia after GA in the early postoperative period in a hospital in Ethiopia(7). The prevalence of POH was 42.3% in a prospective observational study conducted byBerhanu et al (2023) on the magnitude of early postoperative hypoxemia and its associated factors among adult patients undergoing emergency surgery under GA(37). These prospective observational studies had comparable study results as compared to ours.Pediatrics with at least one co-morbidity had a signi cant association with POH with multivariable analysis (p = 0.001) and an AOR of 4.259 (1.788-10.145).…”

“…A single-center retrospective study on risk factors for POH after shoulder arthroscopy by Chen W. et al (2022) described prolonged operation time as signi cantly associated with POH (p = 0.041)(34). A similar prospective observational study byBerhanu et al (2023) on the magnitude of early POH and its associated factors implied that prolonged operation time is signi cantly associated with POH (p = 0.014)…”