Post Anaesthesia Care Unit Discharge: A Clinical Scoring System versus Traditional Time-based Criteria

Comparison of three scoring criteria to assess recovery from general anesthesia in the postanesthesia care unit in the indian population

Background

Different discharge criteria are available for shifting patients out from postanesthesia care room following surgery. This study was done to compare the three-scoring system namely traditional time-based criteria, Fast track criteria and modified Aldrete score, in Indian population patients who recover after general anesthesia in postanesthesia care unit (PACU).

Materials and Methods

Three hundred and seventy-five patients scheduled for general anesthesia were included in this study. Induction of anesthesia was done with intravenous (IV) propofol and maintained with sevoflurane inhalation with oxygen and nitrous oxide. Reversal of residual neuromuscular blockade was done with IV neostigmine and glycopyrrolate. Patients were shifted to PACU following tracheal extubation and recovery was assessed using the traditional time-based criteria, fast track criteria, and modified Aldrete score.

Results

As per modified Aldrete score, mean time of shift out is 19 min with median of 15 min and standard deviation of 21.7 min. As per fast-track score, mean time of shift out is 187 min with median of 30 min and standard deviation of 243.7 min. As per the time-based criteria, mean time of shift out is 222 min with median of 240 min and standard deviation of 136.8 min. While using modified Aldrete score, majority of patients had a shorter stay in PACU and faster time to shift out as compared to fast-track criteria and traditional time-based criteria.

Conclusion

Modified Aldrete score when compared to fast-track scoring and time-based criteria shows early recovery and reduces the length of stay in PACU.

Effect of Interpectoral-Pectoserratus Plane (PECS II) Block on Recovery Room Discharge Time in Breast Cancer Surgery

Background and Objectives: The increase in the incidence and diagnosis rate of breast cancer demands the optimization of resources. The aim of this study was to assess whether the supplementation of the interpectoral-pectoserratus plane block (PECS II) reduces surgery and post-anesthesia care unit (PACU) time in patients undergoing breast cancer surgery. Materials and methods: This was a retrospective data-analysis study. In 2016, PECS II block was introduced as a supplement to general anesthesia for all mastectomies with or without axillary resections in South Jutland regional hospital, Denmark. The perioperative data of patients operated 3 years before and 3 years after 2016 was retrieved through the Danish anesthesia database and patient journals and systematically analyzed. Female patients aged over 18 years, with no use of muscle relaxant, intubation, and inhalation agents, were included. The eligible data was organized into two groups, i.e., Block and Control, where the Block group received PECS II Block, while the Control group received only general anesthesia. Parameters such as surgery time, anesthesia time, PACU time, opioid consumption, and the incidence of postoperative nausea and vomiting (PONV) in PACU were retrieved and statistically analyzed. Results: A total of 172 patients out of 358 patients met eligibility criteria. After applying exclusion criteria, 65 patients were filtered out. A total of 107 patients, 51 from the Block and 56 from the Control group, were eligible for the final analysis. The patients were comparable in demographic parameters. The median surgery time was significantly less in the Block group (78 min (60-99)) in comparison to the Control group (98.5 min (77.5-139.5) p < 0.0045). Consequently, the median anesthesia time was also shorter in the Block group (140 min (115-166)) vs. the Control group (160 min (131.5 to 188), p < 0.0026). Patients from the Block group had significantly lower intraoperative fentanyl consumption (60 µg (30-100)) as compared with the Control group (132.5 µg (80-232.5), p < 0.0001). The total opioid consumption during the entire procedure (converted to morphine) was significantly lower in the Block group (16.37 mg (8-23.6)) as compared with the Control group (31.17 mg (16-46.5), p < 0.0001). No statistically significant difference was found in the PACU time, incidences of PONV, and postoperative pain. Conclusions: The interpectoral-pectoserratus plane (PECS II) block supplementation reduces surgery time, anesthesia time, and opioid consumption but not PACU time during breast cancer surgery.

Postoperative Discharge Scoring Criteria After Outpatient Anesthesia: A Review of the Literature

PURPOSE

The aim of this review was to explore the existing literature on discharge criteria, tools and strategies used in the postanesthesia care unit (PACU) after ambulatory surgery and to identify the essential components of an effective and feasible scoring system based on applicable criteria for the three phases of anesthesia recovery to assess patient discharge after outpatient anaesthesia.

DESIGN

A review of the literature.

METHODS

In this study, a review of sixteen articles was conducted to analyze the affecting factors, evaluation tools, and the current research status of patients discharge after outpatient anesthesia.

FINDINGS

The main factors affecting the discharge after diagnostic or therapeutic procedures under outpatient anesthesia were hospital management, medical treatment and patients themselves. Physiological systems-based discharge assessment had several advantages over traditional time-based discharge assessment. The Aldrete scoring scale was often used for patients in the first stage of anesthesia recovery to leave the PACU, and the Chung's scoring scale was often used to evaluate patients in the second stage of recovery until they leave the hospital. These two scales were often used in combination for outpatient anesthesia. The Fast-tracking assessment tool was used in patients who directly returned to the ward or discharge of patients after ambulatory surgery. There is currently no uniform standard or tool for assessing patients discharge after diagnostic or therapeutic procedures under the outpatient anesthesia.

CONCLUSIONS

Optimal care under anesthesia should allow the patient to recover from anesthesia smoothly and quickly and leave the hospital safely. When the patients can safely leave the hospital after outpatient anesthesia is still a problem that needs to be solved in the nursing field. Various existing scoring systems have their historical advancements, but we need to formulate more in line with the current status of postoperative patients discharge standards.

Unplanned Post-Anesthesia Care Unit to ICU Transfer Following Cerebral Surgery: A Retrospective Study

Background: Unplanned transfer to intensive care unit (ICU) lead to reduced trust of patients and their families in medical staff and challenge medical staff to allocate scarce ICU resources. This study aimed to explore the incidence and risk factors of unplanned transfer to ICU during emergence from general anesthesia after cerebral surgery, and to provide guidelines for preventing unplanned transfer from post-anesthesia care unit (PACU) to ICU following cerebral surgery. Methods: This was a retrospective case-control study and included patients with unplanned transfer from PACU to ICU following cerebral surgery between January 2016 and December 2020. The control group comprised patients matched (2:1) for age (±5 years), sex, and operation date (±48 hours) as those in the case group. Stata14.0 was used for statistical analysis, and p < .05 indicated statistical significance. Results: A total of 11,807 patients following cerebral surgery operations were cared in PACU during the study period. Of the 11,807 operations, 81 unscheduled ICU transfer occurred (0.686%). Finally, 76 patients were included in the case group, and 152 in the control group. The following factors were identified as independent risk factors for unplanned ICU admission after neurosurgery: low mean blood oxygen (OR = 1.57, 95%CI: 1.20-2.04), low mean albumin (OR = 1.14, 95%CI: 1.03-1.25), slow mean heart rate (OR = 1.04, 95%CI: 1.00-1.08), blood transfusion (OR = 2.78, 95%CI: 1.02-7.58), emergency surgery (OR = 3.08, 95%CI: 1.07-8.87), lung disease (OR = 2.64, 95%CI: 1.06-6.60), and high mean blood glucose (OR = 1.71, 95%CI: 1.21-2.41). Conclusion: We identified independent risk factors for unplanned transfer from PACU to ICU after cerebral surgery based on electronic medical records. Early identification of patients who may undergo unplanned ICU transfer after cerebral surgery is important to provide guidance for accurately implementing a patient's level of care.

Using Clinical-Based Discharge Criteria to Discharge Patients After Ophthalmic Ambulatory Surgery Under General Anesthesia: An Observational Study

PURPOSE

To verify the feasibility of the clinical-based discharge (CBD) criteria and identify the reasons of long postanesthesia care unit length of stay (PACU-LOS) for ophthalmic ambulatory surgical patients under general anesthesia.

DESIGN

A prospectively observational study conducted at a tertiary eye center in China.

METHODS

Medical records were collected from patients admitted for strabismus ambulatory surgery under general anesthesia from September 2018 to March 2019. The patients were discharged home once met the CBD criteria based on a combination of the modified Aldrete's scoring system and Chung's Post-Anesthetic Discharge Scoring System. Postoperative complications were recorded in the PACU and within 24 hours after discharge. Multivariate logistic regression was applied to identify the factors relating to late discharges.

FINDINGS

All patients (N = 400) were safely and successfully same-day discharged home as none of the patients informed severe emergency events or unanticipated readmission. Nine displayed discharge delays mainly because of mild postoperative nausea and vomiting (PONV) although met the discharge criteria. About 85.5% of patients were discharged within a PACU-LOS of 150 minutes, 379 (94.8%) were within 180 minutes, and the cutoff time in PACU-LOS was 150 minutes. Multivariable analysis indicated that sevoflurane anesthesia and the presence of PONV were related to late discharges (PACU-LOS of greater than 150 minutes, all P < .05).

CONCLUSIONS

The CBD criteria can efficiently and safely guide the ophthalmic ambulatory surgical patients to discharge home on the same-surgery day, whereas sevoflurane anesthesia and the presence of PONV are associated with a relatively long PACU-LOS.

Implementation of Physiological Scoring to Determine Discharge Readiness for Patients Undergoing Otolaryngology Head and Neck Procedures

PURPOSE

This quality improvement project examined whether the use of a validated physiological scoring protocol to determine discharge readiness for surgical procedures proximal to the airway would decrease the time at which discharge criteria were met and postanesthesia care unit (PACU) length of stay.

DESIGN

An observational pre-post design compared preimplementation recovery times to postimplementation recovery times.

METHODS

PACU nurses were trained to use two physiological scoring protocols to determine when patients met discharge criteria and to document when discharge criteria were met.

FINDINGS

During the postimplementation period, there was a significant decrease in the time it took patients to meet PACU discharge criteria when using the physiological scoring protocols compared with the preimplementation group (P < .001).

CONCLUSIONS

These results suggest that physiological scoring protocols are safe and appropriate to determine discharge readiness for patients who have surgery proximal to the airway.

Are Postoperative Clinical Outcomes Influenced by Length of Stay in the Postanesthesia Care Unit?

PURPOSE

To compare clinical outcomes of patients who required a prolonged length of stay in the postanesthesia care unit (PACU) with a control group.

DESIGN

A single-center purposive-sampled retrospective medical record and database audit.

METHODS

Patients with prolonged PACU stays were compared to a group of patients whose stay was less than median for outcome measures: rapid response team (RRT) activation, cardiac arrest, unanticipated intensive care unit admissions, and survival to discharge.

FINDINGS

A total of 1,867 patients were included in the analysis (n = 931 prolonged stay and n = 933 control group). Prolonged stay in PACU was higher among patients who were older, had higher American Society of Anesthesiologist score, and were discharged to wards during the afternoon or late nursing shift. RRT activation after discharge from PACU occurred in more patients in the study group compared with the control group (7% vs 1%, respectively). There were no cardiac arrests recorded in either group within the 24 hours after PACU discharge period.

CONCLUSIONS

Prolonged stay in the PACU for 2 or more hours because of clinical reasons appears to be associated with a higher incidence of clinical deterioration in the ward setting requiring RRT intervention within 24 hours after discharge from PACU.

Decreasing Postanesthesia Care Unit to Floor Transfer Times to Facilitate Short Stay Total Joint Replacements

PURPOSE

We describe a process for studying and improving baseline postanesthesia care unit (PACU)-to-floor transfer times after total joint replacements.

DESIGN

Quality improvement project using lean methodology.

METHODS

Phase I of the investigational process involved collection of baseline data. Phase II involved developing targeted solutions to improve throughput. Phase III involved measured project sustainability.

FINDINGS

Phase I investigations revealed that patients spent an additional 62 minutes waiting in the PACU after being designated ready for transfer. Five to 16 telephone calls were needed between the PACU and the unit to facilitate each patient transfer. The most common reason for delay was unavailability of the unit nurse who was attending to another patient (58%). Phase II interventions resulted in transfer times decreasing to 13 minutes (79% reduction, P < .001). Phase III recorded sustained transfer times at 30 minutes, a net 52% reduction (P < .001) from baseline.

CONCLUSIONS

Lean methodology resulted in the immediate decrease of PACU-to-floor transfer times by 79%, with a 52% sustained improvement. Our methods can also be used to improve efficiencies of care at other institutions.

A prospective observational study comparing criteria-based discharge method with traditional time-based discharge method for discharging patients from post-anaesthesia care unit undergoing ambulatory or outpatient minor surgeries under general anaesthesia

Background and Aims:

Mostly, institutions in India have single post-anaesthesia care unit (PACU) which follows traditional time-based discharge (TBD) method. Recently, it has been classified into PACU Phase I and Phase II, and criteria-based discharge (CBD) method has been used. This study primarily compares CBD versus TBD methods in moving patients through PACU, and other non-clinical factors causing delay in shifting.

Methods:

One hundred patients, aged 18–65 years, American Society of Anesthesiologist's physical status I and II, scheduled for elective minor surgeries under general anaesthesia were studied. White's fast-track score in operating room (OR) and modified Aldrete's score (CBD time) in PACU were recorded. Patients were scheduled to discharge at 60 min based on TBD method. The mean CBD time and actual discharge time from PACU were statistically compared with TBD time. Other non-clinical factors delaying the discharge were also studied.

Results:

Eighty-five percent of patients achieved acceptable White's fast-track score in OR. The TBD time (60 min) was compared with the mean CBD time (10.70 ± 2.56 min) and actual discharge time (79.75 ± 12.98 min), which were found to be statistically significant. Primarily, anaesthesiologists' busy schedule was accountable for delay in discharge.

Conclusion:

The study concluded that in patients undergoing ambulatory minor surgeries, discharge times based on Criterion Based Discharge scoring systems such as modified Aldrete's and White's-fast are significantly lower in PACU Phase I as compared to the traditional Time Based Discharge method.

Retrospective review of critical incidents in the post-anaesthesia care unit at a major tertiary hospital

INTRODUCTION

We reviewed patients with critical incidents that occurred in the post-anaesthesia care unit (PACU) at a major tertiary hospital, and assessed the effect of these incidents on PACU length of stay and discharge disposition.

METHODS

A retrospective review was conducted of patients in the PACU over a two-year period from 24 June 2011 to 23 August 2013. Data on critical incidents was recorded in the administrative database using a standardised data form.

RESULTS

There were 701 incidents involving 364 patients; 203 (55.8%) patients had American Society of Anesthesiologists (ASA) physical status I or II. The most common critical incidents were cardiovascular-related (n = 293, 41.8%), respiratory (n = 155, 22.1%), neurological (n = 52, 7.4%), surgical (n = 47, 6.7%) and airway-related (n = 34, 4.9%). There were two incidents of cardiac arrest and 25 incidents of unexpected reintubations. Many patients (n = 186, 51.2%) stayed for over four hours in the PACU due to critical incidents and 184 (50.5%) patients required a higher level of care postoperatively than initially planned. Some patients (n = 34, 9.3%) returned to the operation theatre for further management. A proportion of patients (n = 64, 17.6%) had unplanned intensive care unit admissions due to adverse events in the PACU.

CONCLUSION

A wide spectrum of critical incidents occur in the PACU, many of which are related to the cardiovascular and respiratory systems. Critical incidents have a major impact on healthcare utilisation and result in prolonged PACU stays and higher levels of postoperative care than initially anticipated.

Fast-track recovery after day case surgery

BACKGROUND

Fast-track recovery processes are implemented for pediatric day case surgery. We conducted a prospective study to evaluate postoperative comfort and parental satisfaction of children included in this process to improve quality of care.

METHODS

We included all children scheduled for superficial procedures or dental treatment outside the operating room. A questionnaire was explained to parents before hospital discharge to evaluate the first night at home. Postoperative comfort evaluation included postoperative pain score (FLACC scale), incidence of postoperative nausea and vomiting, and postoperative behavior disorders. Incidence of posthospital behavior disturbance was evaluated measuring postoperative agitation at home, and disinterest with toys and games. Parental satisfaction was evaluated with a four-point Likert scale (1 = not satisfied at all, 2 = not satisfied, 3 = satisfied, 4 = very satisfied).

RESULTS

One hundred and forty-three questionnaires were returned to hospital. Despite reduced length of stay in short-stay unit after anesthesia (28 ± 34 min), we did not report serious complications, and global parental satisfaction was good about the care process. Pain scores (FLACC >3) were higher in the group scheduled for dental procedures, but were very low for the other superficial surgery. With an odd ratio of 5.8 (95% confidence interval 2-17; P = 0.001), postoperative behavior modification (agitation or disinterest with toys or games) was the strongest variable that can predict parental dissatisfaction.

CONCLUSION

Optimal pain management, better parental information about risks of postoperative behavior disturbances, and program integrating parent and child preparation should improve quality of care and global satisfaction in the fast-track recovery process.

Postoperative issues: discharge criteria

With the continuous increase in the numbers and complexity of cases being done as ambulatory procedures, striking a balance between operational efficiency, patient safety, and patient satisfaction has become increasingly difficult. This article summarizes the latest evidence and consensus with regard to discharging an ambulatory patient home, the use of patient recovery scoring systems for protocol-based decision making, the concept of fast-track recovery, and requirements for patient escort. Fast-tracking (ie, bypassing the postanesthesia care unit) is an acceptable and safe pathway, provided careful patient selection and assessment are performed.

Conscious Sedation and Analgesia in Colonoscopy: Ketamine/Propofol Combination has Superior Patient Satisfaction Versus Fentanyl/Propofol

Background

Colonoscopy is performed without preparing sedation in many countries. However, according to the current literature patients are more satisfied when appropriate sedation is prepared for them.

Objectives

We hypothesize that propofol-ketamine may prepare more patient satisfaction compared to propofol-fentanyl combination.

Patients and Methods

Sixty adult patients older than 18 with ASA physical status of I, II or III were enrolled in the present study after providing the informed consent. They were prospectively randomized into two equal groups: 1- Group PF: was scheduled to receive IV bolus dose of fentanyl 1µg/kg and propofol 0.5mg/kg. 2- Group PK: was scheduled to receive IV bolus dose of ketamine 0.5mg/kg and propofol 0.5mg/kg. As a primary goal, patient’s satisfaction was assessed by the use a Likert five-item scoring system in the recovery. Comparisons of hemodynamic parameters (mean heart rate, mean systolic blood pressure, mean diastolic blood pressure), mean Spo2 values during the procedure and side effects such as nausea, vomiting, and psychological reactions during the recovery period were our secondary goals. Level of sedation during the colonoscopy was assessed with the Observer’s Assessment of Alertness/Sedation score (OAA/S).

Results

Mean satisfaction scores in the group PK were significantly higher than the group PF (P = 0.005) while the level of sedation during the procedure was similar (P = 0.17). Hemodynamic parameters and SpO2 values were not significantly different (P > 0.05). Incidence of nausea and vomiting was the same in both groups.

Conclusions

IV bolus injection of propofol-ketamine can lead to more patients’ satisfaction than the other protocols during colonoscopy.

Postoperative Recovery with Bispectral Index versus Anesthetic Concentration–guided Protocols

Background:

Use of the bispectral index (BIS) monitor has been suggested to decrease excessive anesthetic drug administration, leading to improved recovery from general anesthesia. The purpose of this substudy of the B-Unawareand BAG-RECALL trials was to assess whether a BIS-based anesthetic protocol was superior to an end-tidal anesthetic concentration–based protocol in decreasing recovery time and postoperative complications.

Methods:

Patients at high risk for awareness were randomized to either BIS-guided or end-tidal anesthetic concentration–guided general anesthesia in the original trials. Outcomes included time to postanesthesia care unit discharge readiness, time to achieve a postoperative Aldrete score of 9–10, intensive care unit length of stay, postoperative nausea and vomiting, and severe postoperative pain. Univariate Cox regression and chi-square tests were used for statistical analyses.

Results:

The BIS cohort was not superior in time to postanesthesia care unit discharge readiness (hazard ratio, 1.0; 95% CI, 1.0–1.1; n = 2,949), time to achieve an Aldrete score of 9–10 (hazard ratio, 1.2; 95% CI, 1.0–1.4; n = 706), intensive care unit length of stay (hazard ratio, 1.0; 95% CI, 0.9–1.1; n = 2,074), incidence of postoperative nausea and vomiting (absolute risk reduction, −0.5%; 95% CI, −5.8 to 4.8%; n = 789), or incidence of severe postoperative pain (absolute risk reduction, 4.4%; 95% CI, −2.3 to 11.1%; n = 759).

Conclusions:

In patients at high risk for awareness, the BIS-guided protocol is not superior to an anesthetic concentration–guided protocol in time needed for postoperative recovery or in the incidences of common postoperative complications.

Prolonged recovery after out-patient pediatric adenotonsillectomy

OBJECTIVE

To determine variables predictive of recovery room times in pediatric outpatient adenotonsillectomy.

STUDY DESIGN

Retrospective case-control.

METHODS

One-hundred ninety consecutive patients undergoing outpatient adenotonsillectomy at an ambulatory surgery center of a tertiary-care free standing pediatric hospital were grouped into upper and lower deciles of recovery room times. Twenty-one variables were analyzed to determine which variables are predictive of prolonged recovery time. Univariate and multivariate analyses were performed.

RESULTS

Of the 190 patients, mean recovery room time was 103 min (SD 53.1), 22 patients were in the lower decile (mean recovery room time of 63 ± 6 min) and 17 patients were in the upper decile (155 ± 40 min, P<0.0001). Of the 21 variables analyzed, post-anesthesia care unit (PACU) nursing staff was the only significant predictor of prolonged recovery room time. Compared with one PACU nurse, other nurses (N=5) predicted a longer recovery time (OR=10.8, 95% CI 2.0-59.5, P=0.0017). This association remained significant when controlling for anesthesiologist and surgeon (OR=8.8, 95% CI 1.5-50.9, P=0.0072). There were no complications in any patients.

CONCLUSIONS

Recovery room times after outpatient adenotonsillectomy vary significantly (mean 103 min (SD 53.1), range 50-241 min). Of potential predictors, only the human factor (PACU nursing staff) was associated with prolonged recovery room times, independent of surgeon and anesthesiologist. Development of standardized protocols for nurses to use for discharge has the potential to increase throughput for adenotonsillectomy patients in an outpatient surgery center setting.

Pain assessment and management in patients after abdominal surgery from PACU to the postoperative unit

The aim of this exploratory study was to determine the effectiveness of pain relief for surgical patients (N = 52) in transition from the PACU to the postoperative unit. The study also explored whether there was an association between a verbal numeric pain score (0 to 10) on discharge from the PACU and the duration of time until analgesia was administered in the postoperative unit. Information was obtained about pain management, time of discharge, and patient pain scores on discharge from the PACU, as well as pain scores and the time of first analgesic administered in the postoperative unit. Most patients were discharged from the PACU with a pain score in the mild range (0 to 4), indicating reasonable pain relief. An association existed between the pain score on discharge from the PACU and the duration of time to the first analgesic dose administered on the postoperative unit.

[Dolasetron and shivering. A prospective randomized placebo-controlled pharmaco-economic evaluation]

BACKGROUND AND GOAL

Forced by the current economical situation, German hospitals have to reconsider their clinical productivity. When caregivers introduce new therapeutic concepts medical quality should either be improved without increasing costs or when reducing costs medical quality should be maintained. In the surgical field postoperative shivering reduces both patient comfort and medical quality. We therefore investigated the clinical pathway prevention of shivering with dolasetron in a prospective, randomized, placebo-controlled analysis of cost-effectiveness.

MATERIAL AND METHODS

After written informed consent we randomized 40 patients scheduled for lumbar disc hernia repair or head and neck surgery into two groups: patients of group D received dolasetron 1 mg/kg body weight during surgery whereas patients of group K received 100 ml saline as placebo. Primary endpoints were the incidence of shivering, the length of stay in the postanesthesia care unit and process-associated costs. Secondary endpoint was the influence on perioperative thermoregulation.

RESULTS

We observed postanesthetic shivering in 5 patients belonging to group D in comparison to 15 patients receiving the placebo (p<0.05). The length of stay in the postanesthesia care unit was shorter in patients allocated to dolasetron (mean+/-SD; group D: 43+/-16 min, group K 62+/-18 min, p<0.05). There was a significant saving in process-associated personnel costs (personnel costs in group D EUR 41.26+/-14, personnel costs in group K EUR 53.15+/-15) but in contrast the process-associated material costs were significantly increased (group D EUR 17.16+/-3, group K EUR 0.73+/-1, p<0.05).

CONCLUSIONS

The optimization of the clinical process and medical quality induced by a prophylaxis against shivering and postoperative nausea and vomiting compensates for the increased use of pharmaceutical resources in our setting.

Post anaesthetic care units in the Republic of Ireland: a survey of discharge criteria

Discharge readiness of patients from the post anaesthetic care unit (PACU) is often determined by specific discharge criteria. This quantitative, descriptive national study aimed to survey discharge criteria used in the PACU. Data from 45 hospitals nationally with a response rate of 77.8% (n = 35) was gathered. Specific discharge criteria were used by 71.4% (n = 25) of the PACUs in the determination of fitness of patients for discharge from the PACU.

Is Postanesthesia Care Unit Length of Stay: Increased in Hypothermic Patients?

Inadvertent hypothermia is one of the most common complications experienced by surgical patients who are transferred to the postanesthesia care unit (PACU). Appropriate pacu length of stay (LOS) is defined as the time required for a patient to achieve a physiologically stable condition after anesthesia administration. In studies measuring appropriate LOS, patients who arrived hypothermic in the PACU had longer stays than those who arrived normothermic. The aims of this study were to determine whether the actual and appropriate LOS in the PACU differs between hypothermic and normothermic patients and to identify differences between subgroups of patients according to age, gender, and type of anesthesia administered.