The association of early postoperative desaturation in the operating theatre with hospital discharge to a skilled nursing or long‐term care facility

Abstract

It is unclear which criteria should be used to define readiness for tracheal extubation in the operating theatre. We studied the effects of desaturation in the operating theatre immediately after tracheal extubation on longterm outcomes. Performing a pre-specified, retrospective analysis of 71,025 cases involving previously independent adults undergoing non-cardiac surgery, we evaluated the association between desaturation events (oxygen saturation < 90%) within 10 min of tracheal extubation and adverse discharge (to a skilled nursing facility or long-term care facility). A total of 404 (12.3%) cases with, and 5035 (7.4%) cases without, early postoperative desaturation had an adverse discharge. Early postoperative desaturation was associated with higher odds of being discharged to a nursing facility (adjusted odds ratio 1.36 (95%CI 1.20-1.54); p < 0.001). Increased duration of desaturation augmented the effect (p for trend < 0.001). Desaturation was associated with a higher risk of respiratory, renal and cardiovascular complications as well as increased duration of hospital stay, postoperative intensive care unit admission frequency and cost. Several modifiable factors were associated with desaturation including: high intra-operative long-acting opioid administration; high neostigmine dose; high intra-operative inspired oxygen concentration; and low oxygen delivery immediately before tracheal extubation. There was substantial provider variability between anaesthetists in the incidence of postoperative desaturation unexplained by patient-and procedure-related factors. Early postoperative desaturation is a potentially preventable complication associated with a higher risk of adverse discharge disposition.

A comparison of postoperative respiratory complications associated with the use of desflurane and sevoflurane: a single‐centre cohort study

“…Re‐intubation and the need for invasive ventilation is a significant postoperative event and a reliably documented and accepted patient safety indicator [24]. Immediate post‐extubation desaturation is associated with an increase in postoperative pulmonary complications, including increased re‐intubation risk, and may be caused by atelectasis, shunting and other respiratory complications [27]. We have validated these objective markers of respiratory failure in our database and have used this composite outcome in previous studies [17].…”

Discharge Prediction for Patients Undergoing Inpatient Surgery: Development and validation of the DEPENDENSE score

“…Candidate predictors considered for score development were identified a priori based on biological plausibility, clinical relevance and a comprehensive literature review. 4,[13][14][15] These variables included patient age, sex, estimated household income based on residential Zone Improvement Plan (ZIP) code, insurance status, American Society of Anesthesiologists (ASA) physical status classification, body mass index (BMI), comorbid conditions, hospital length of stay (LOS) prior to surgery and procedural characteristics. Detailed information on all predictors can be found in Supporting Information (Section B1, Table S1a,b).…”

“…Given the considerably large sample size and our prior work, we expected numerous predictor-outcome associations to reach very low p-values. 13 Bootstrapping with 1000 samples was performed to obtain a more reliable standard error and P value for each coefficient and to further eliminate predictors that did not promote model fit. To address potential overfitting, additional confirmatory analyses were performed including leave-one-out cross validation and penalized maximum likelihood regression (Supporting Information, Section B).…”

Hypoxaemia during recovery after surgery for colorectal cancer: a prospective observational study

“…Episodic and ongoing hypoxaemia are well‐known phenomena after surgery, and are associated with serious postoperative events such as myocardial ischaemia , arrhythmias , cognitive dysfunction , surgical complications and impaired wound healing . Even short‐term hypoxaemia in the early postoperative period may be associated with an increased risk of long‐term adverse events, and these risks increase with duration of the hypoxaemia . The exact pathophysiological mechanisms are uncertain, but patient characteristics such as obstructive sleep apnoea , morphine use , incision site near the diaphragm and excessive fluid administration have been found to be associated with hypoxaemia.…”