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
目的探讨老年非心脏全麻手术患者延迟转出麻醉后监测治疗室(post-anesthesia care unit,PACU)的独立影响因素,涵盖术前状态、术中管理及创新性时间节律等维度,为优化围术期管理提供参考。方法本研究采用回顾性病例对照研究(retrospectiv...目的探讨老年非心脏全麻手术患者延迟转出麻醉后监测治疗室(post-anesthesia care unit,PACU)的独立影响因素,涵盖术前状态、术中管理及创新性时间节律等维度,为优化围术期管理提供参考。方法本研究采用回顾性病例对照研究(retrospective case-control study)设计,选取2021年1月至2023年12月期间于陆军军医大学第一附属医院麻醉科接受非心脏全麻手术且进入PACU复苏的1469例老年(≥60岁)患者为研究对象。依据“入PACU至达到改良Aldrete评分≥9分、时间是否超过120 min”,将患者分为延迟组(n=709)和未延迟组(n=760)。通过医院住院管理系统及临床麻醉信息系统,收集患者人口学特征、术前合并症、美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级、术中管理指标、术后监测指标、入恢复室相关指标及手术开始/入PACU时间节律数据。首先采用卡方检验或二元Logistic回归对两组患者的各项指标进行单因素比较;然后将单因素分析中P<0.05的变量纳入二元Logistic逐步回归模型,分析延迟转出PACU的独立影响因素。结果单因素分析显示,延迟组在男性比例、ASA分级Ⅲ-Ⅳ级、合并呼吸系统疾病、术中使用血管活性药物及胶体、术中总入量和总出量、术中出血量、术后使用静脉镇痛和神经阻滞镇痛、手术及麻醉持续时间及入PACU体温等方面均显著高于未延迟组(P<0.05),而延迟组使用肌松拮抗剂新斯的明的比例和术后血红蛋白浓度更低(P<0.05)。时间节律方面,2组在手术开始时辰和入PACU时辰的分布上存在显著差异(P<0.001)。多因素分析显示,术前合并呼吸系统疾病(β=0.616,P<0.001)、ASA分级Ⅲ-Ⅳ级(β=0.501,P=0.002)、术中使用胶体(β=0.626,P<0.001)、术中总入量增加(β=0.001,P<0.001)、手术开始于巳时(9~11点)(β=0.353,P=0.005)及入PACU时间为申时(15~17点)(β=0.660,P<0.001)是延迟转出的独立危险因素。而使用肌松拮抗剂新斯的明(β=-0.327,P=0.007)及在戌时(19~21点)进入PACU(β=-0.468,P=0.042)是独立保护因素。结论老年患者全麻术后延迟转出PACU受患者术前状态、术中管理、术后管理及手术时间节律等多因素共同影响。针对高危老年患者实施个体化麻醉与液体管理,使用肌松拮抗剂,并在手术安排与PACU资源配置中考虑时间节律效应,有可能降低其全麻术后延迟转出PACU的发生率。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>
文摘目的探讨老年非心脏全麻手术患者延迟转出麻醉后监测治疗室(post-anesthesia care unit,PACU)的独立影响因素,涵盖术前状态、术中管理及创新性时间节律等维度,为优化围术期管理提供参考。方法本研究采用回顾性病例对照研究(retrospective case-control study)设计,选取2021年1月至2023年12月期间于陆军军医大学第一附属医院麻醉科接受非心脏全麻手术且进入PACU复苏的1469例老年(≥60岁)患者为研究对象。依据“入PACU至达到改良Aldrete评分≥9分、时间是否超过120 min”,将患者分为延迟组(n=709)和未延迟组(n=760)。通过医院住院管理系统及临床麻醉信息系统,收集患者人口学特征、术前合并症、美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级、术中管理指标、术后监测指标、入恢复室相关指标及手术开始/入PACU时间节律数据。首先采用卡方检验或二元Logistic回归对两组患者的各项指标进行单因素比较;然后将单因素分析中P<0.05的变量纳入二元Logistic逐步回归模型,分析延迟转出PACU的独立影响因素。结果单因素分析显示,延迟组在男性比例、ASA分级Ⅲ-Ⅳ级、合并呼吸系统疾病、术中使用血管活性药物及胶体、术中总入量和总出量、术中出血量、术后使用静脉镇痛和神经阻滞镇痛、手术及麻醉持续时间及入PACU体温等方面均显著高于未延迟组(P<0.05),而延迟组使用肌松拮抗剂新斯的明的比例和术后血红蛋白浓度更低(P<0.05)。时间节律方面,2组在手术开始时辰和入PACU时辰的分布上存在显著差异(P<0.001)。多因素分析显示,术前合并呼吸系统疾病(β=0.616,P<0.001)、ASA分级Ⅲ-Ⅳ级(β=0.501,P=0.002)、术中使用胶体(β=0.626,P<0.001)、术中总入量增加(β=0.001,P<0.001)、手术开始于巳时(9~11点)(β=0.353,P=0.005)及入PACU时间为申时(15~17点)(β=0.660,P<0.001)是延迟转出的独立危险因素。而使用肌松拮抗剂新斯的明(β=-0.327,P=0.007)及在戌时(19~21点)进入PACU(β=-0.468,P=0.042)是独立保护因素。结论老年患者全麻术后延迟转出PACU受患者术前状态、术中管理、术后管理及手术时间节律等多因素共同影响。针对高危老年患者实施个体化麻醉与液体管理,使用肌松拮抗剂,并在手术安排与PACU资源配置中考虑时间节律效应,有可能降低其全麻术后延迟转出PACU的发生率。
