Adverse Respiratory Events Increase Post-anesthesia Care Unit Stay in China: A 2-year Retrospective Matched Cohort Study.

Abstract

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 inpatient 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. 11.19±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.