Despite growing attention to patients,safety worldwide,no data were available on the impact of adverse respiratory events(AREs)on post-anesthesia care and post-operation care in China.This study evaluated the occurren...Despite growing attention to patients,safety worldwide,no data were available on the impact of adverse respiratory events(AREs)on post-anesthesia care and post-operation care in China.This study evaluated the occurrence of AREs,the impact of AREs on length of stay(LOS)in post-anesthesia care unit(PACU)and postoperative time in hospital,and PACU cost and in patient healthcare costs.A retrospective,matched-cohort study was conducted by prospectively collecting the data of 159 AREs in PACU during 2016-2017 in an university hospital in China.Records were reviewed by pre-trained,qualified nurses and/or anesthesiologists.The incidence and the impact of AREs were analyzed.The LOS in PACU and postoperative time in hospital and the costs in PACU and inpatient healthcare costs were also obtained.Results showed that there were 253 AREs involving 156 patients.Hypoxia(n=141,55.73%)and respiratory depression(n=70,27.67%)were the most common AREs.Measurement data including body mass index(BMI)(22.85±4.36 vs.22.32±3.83),duration of procedure(138.47±77.33 min vs.137.44±72.33 min),duration of anesthesia(176.35±82.66 min vs.174.61±78.08 min),LOS(16.53±10.65 days vs.16.57±9.56 days),inpatient healthcare costs($9465.57±9416.33 vs.$8166.51±5762.01),and postoperative LOS(11.26±8.77 days vs.11.9±8.30 days)showed no significant differences between ARE and matched groups(P<0.05).Duration(81.65±54.79 min vs.38.89±26.09 min)and costs($31.99±17.80 vs.$18.72±8.39)in PACU were significantly different in ARE group from those in matched group(P<0.001).Proportion of patients with prolonged stay in PACU was significantly higher in ARE group than in matched group(18.59%vs.1.28%),with an odds ratio(after matching)of 17.58(95%CI=4.11 to 75.10;P<0.001).The AREs that occurred during the immediate postoperative period in PACU increased the incidence rate of prolonged stay,delayed the PACU stay,and increased the costs in PACU,resulting in the need of higher levels of postoperative care than anticipated,but the postoperative LOS and inpatient healthcare costs were unchanged.展开更多
Background: Inadvertent postoperative hypothermia (IPH) is known to be associated with various adverse effects. The aim of this study was to evaluate the incidence, predictors and outcome of core inadvertent hypotherm...Background: Inadvertent postoperative hypothermia (IPH) is known to be associated with various adverse effects. The aim of this study was to evaluate the incidence, predictors and outcome of core inadvertent hypothermia on admission in the post-anesthesia care unit. Methods: Observational, prospective study in a Post-Anesthesia Care Unit. The study population consisted of adult patients after non-cardiac and non-neurologic surgery. Patients’ demographics, intraoperative and postoperative data were collected. Descriptive analysis of variables was used to summarize data and the Mann-Whitney U test, Fisher’s exact test or Chi-square test was used. Univariate and multivariate analyses were done with logistic binary regression with calculation of an Odds Ratio (OR) and its 95% Confidence Interval. Results: The incidence of IPH on admission was 32%. In univariate analysis: age, body mass index (BMI), high risk surgery, revised cardiac risk index (RCRI), type of anesthesia, use of forced-air warming, amount of intravenous crystalloids administrated, duration of anesthesia, duration of surgery and admission visual analogue scale (VAS) for pain > 3 were considered predictors of hypothermia. In multiple logistic regression analysis, age (OR 1.7, P = 0.045, for age > 65 years), RCRI (OR 3.18, P = 0.041, for RCRI > 2), duration of anesthesia (OR 1.52, P < 0.001) and admission VAS for pain (OR 2.05, P = 0.007) were considered independent predictors of IPH. Patients with IPH at PACU admission stay longer in the PACU. Conclusions: IPH was associated with a longer stay in the PACU. Age, comorbidities duration of anesthesia and pain at PACU admission were considered independent predictors for IPH.展开更多
<strong>Background:</strong><span style="font-family:;" "=""><span style="font-family:Verdana;"> Gabapentin is routinely prescribed preoperatively to decrease...<strong>Background:</strong><span style="font-family:;" "=""><span style="font-family:Verdana;"> Gabapentin is routinely prescribed preoperatively to decrease postoperative pain intensity. It is included in the enhanced recovery after surgery (ERAS) recommendations. </span><b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> To analyze correlation of gabapentin dosage and post anesthesia care unit (PACU) length of stay (LOS) and cost. </span><b><span style="font-family:Verdana;">Study Design:</span></b><span style="font-family:Verdana;"> A retrospective chart review of patients who underwent general anesthesia and received preoperative oral gabapentin from June 2017 </span></span><span style="font-family:Verdana;">to</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> August 2017 for pelvic and breast procedures. The main outcome was correlation between PACU LOS and gabapentin dosage in the outpatients. Financial analysis was performed to assess the cost to the hospital associated with increased LOS. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Of the 636 patients, 405 patients received 300 </span><span style="font-family:Verdana;">mg and 231 patients received 100 mg gabapentin. Mean dosage per kg (mg/k</span><span style="font-family:Verdana;">g ±</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">SD) was 3.12</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">±</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">1.51 (range: </span><span style="font-family:Verdana;">0</span><span style="font-family:Verdana;">.86 to 6.12). PACU LOS was 96</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">±</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">77 (minutes ±</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">SD) in patients receiving 100 mg and 120</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">±</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">96 in patients receiving 300 mg capsule (p</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">=</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">0.001). Linear regression analysis, failed to show a </span><span style="font-family:Verdana;">statistically significant correlation between per kg dosage and PACU LOS (</span><span style="font-family:Verdana;">p</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> 0</span><span style="font-family:Verdana;">.13). Using multiple regression analysis, we calculated the correlation coefficient to be +1.71 minutes per 1mg/kg gabapentin (95% CI: -</span><span style="font-family:Verdana;">3.75 to +7.10, p</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> 0</span><span style="font-family:Verdana;">.54) after adjusting for confounders. Adding 3</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">mg/kg to pre-op g</span><span style="font-family:Verdana;">abapentin dosage of all outpatients cost on average</span></span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> an extra $9794 per mo</span><span style="font-family:;" "=""><span style="font-family:Verdana;">nth in this cohort. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Every 1mg/kg increase in gabapentin dosage adds an estimated 7.1 minutes to PACU LOS. A 3</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">mg/kg increase in gabapentin adds estimated 22 additional minutes in PACU LOS. Unfortunately, increase LOS is associated with increased hospital costs.</span>展开更多
文摘Despite growing attention to patients,safety worldwide,no data were available on the impact of adverse respiratory events(AREs)on post-anesthesia care and post-operation care in China.This study evaluated the occurrence of AREs,the impact of AREs on length of stay(LOS)in post-anesthesia care unit(PACU)and postoperative time in hospital,and PACU cost and in patient healthcare costs.A retrospective,matched-cohort study was conducted by prospectively collecting the data of 159 AREs in PACU during 2016-2017 in an university hospital in China.Records were reviewed by pre-trained,qualified nurses and/or anesthesiologists.The incidence and the impact of AREs were analyzed.The LOS in PACU and postoperative time in hospital and the costs in PACU and inpatient healthcare costs were also obtained.Results showed that there were 253 AREs involving 156 patients.Hypoxia(n=141,55.73%)and respiratory depression(n=70,27.67%)were the most common AREs.Measurement data including body mass index(BMI)(22.85±4.36 vs.22.32±3.83),duration of procedure(138.47±77.33 min vs.137.44±72.33 min),duration of anesthesia(176.35±82.66 min vs.174.61±78.08 min),LOS(16.53±10.65 days vs.16.57±9.56 days),inpatient healthcare costs($9465.57±9416.33 vs.$8166.51±5762.01),and postoperative LOS(11.26±8.77 days vs.11.9±8.30 days)showed no significant differences between ARE and matched groups(P<0.05).Duration(81.65±54.79 min vs.38.89±26.09 min)and costs($31.99±17.80 vs.$18.72±8.39)in PACU were significantly different in ARE group from those in matched group(P<0.001).Proportion of patients with prolonged stay in PACU was significantly higher in ARE group than in matched group(18.59%vs.1.28%),with an odds ratio(after matching)of 17.58(95%CI=4.11 to 75.10;P<0.001).The AREs that occurred during the immediate postoperative period in PACU increased the incidence rate of prolonged stay,delayed the PACU stay,and increased the costs in PACU,resulting in the need of higher levels of postoperative care than anticipated,but the postoperative LOS and inpatient healthcare costs were unchanged.
文摘Background: Inadvertent postoperative hypothermia (IPH) is known to be associated with various adverse effects. The aim of this study was to evaluate the incidence, predictors and outcome of core inadvertent hypothermia on admission in the post-anesthesia care unit. Methods: Observational, prospective study in a Post-Anesthesia Care Unit. The study population consisted of adult patients after non-cardiac and non-neurologic surgery. Patients’ demographics, intraoperative and postoperative data were collected. Descriptive analysis of variables was used to summarize data and the Mann-Whitney U test, Fisher’s exact test or Chi-square test was used. Univariate and multivariate analyses were done with logistic binary regression with calculation of an Odds Ratio (OR) and its 95% Confidence Interval. Results: The incidence of IPH on admission was 32%. In univariate analysis: age, body mass index (BMI), high risk surgery, revised cardiac risk index (RCRI), type of anesthesia, use of forced-air warming, amount of intravenous crystalloids administrated, duration of anesthesia, duration of surgery and admission visual analogue scale (VAS) for pain > 3 were considered predictors of hypothermia. In multiple logistic regression analysis, age (OR 1.7, P = 0.045, for age > 65 years), RCRI (OR 3.18, P = 0.041, for RCRI > 2), duration of anesthesia (OR 1.52, P < 0.001) and admission VAS for pain (OR 2.05, P = 0.007) were considered independent predictors of IPH. Patients with IPH at PACU admission stay longer in the PACU. Conclusions: IPH was associated with a longer stay in the PACU. Age, comorbidities duration of anesthesia and pain at PACU admission were considered independent predictors for IPH.
文摘<strong>Background:</strong><span style="font-family:;" "=""><span style="font-family:Verdana;"> Gabapentin is routinely prescribed preoperatively to decrease postoperative pain intensity. It is included in the enhanced recovery after surgery (ERAS) recommendations. </span><b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> To analyze correlation of gabapentin dosage and post anesthesia care unit (PACU) length of stay (LOS) and cost. </span><b><span style="font-family:Verdana;">Study Design:</span></b><span style="font-family:Verdana;"> A retrospective chart review of patients who underwent general anesthesia and received preoperative oral gabapentin from June 2017 </span></span><span style="font-family:Verdana;">to</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> August 2017 for pelvic and breast procedures. The main outcome was correlation between PACU LOS and gabapentin dosage in the outpatients. Financial analysis was performed to assess the cost to the hospital associated with increased LOS. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Of the 636 patients, 405 patients received 300 </span><span style="font-family:Verdana;">mg and 231 patients received 100 mg gabapentin. Mean dosage per kg (mg/k</span><span style="font-family:Verdana;">g ±</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">SD) was 3.12</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">±</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">1.51 (range: </span><span style="font-family:Verdana;">0</span><span style="font-family:Verdana;">.86 to 6.12). PACU LOS was 96</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">±</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">77 (minutes ±</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">SD) in patients receiving 100 mg and 120</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">±</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">96 in patients receiving 300 mg capsule (p</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">=</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">0.001). Linear regression analysis, failed to show a </span><span style="font-family:Verdana;">statistically significant correlation between per kg dosage and PACU LOS (</span><span style="font-family:Verdana;">p</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> 0</span><span style="font-family:Verdana;">.13). Using multiple regression analysis, we calculated the correlation coefficient to be +1.71 minutes per 1mg/kg gabapentin (95% CI: -</span><span style="font-family:Verdana;">3.75 to +7.10, p</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> 0</span><span style="font-family:Verdana;">.54) after adjusting for confounders. Adding 3</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">mg/kg to pre-op g</span><span style="font-family:Verdana;">abapentin dosage of all outpatients cost on average</span></span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> an extra $9794 per mo</span><span style="font-family:;" "=""><span style="font-family:Verdana;">nth in this cohort. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Every 1mg/kg increase in gabapentin dosage adds an estimated 7.1 minutes to PACU LOS. A 3</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">mg/kg increase in gabapentin adds estimated 22 additional minutes in PACU LOS. Unfortunately, increase LOS is associated with increased hospital costs.</span>
