Pilot study comparing post-anesthesia care unit length of stay in moderately and severely obese children

A novel nomogram for predicting the prolonged length of stay in post-anesthesia care unit after elective operation

BACKGROUND

Prolonged length of stay in post-anesthesia care unit (PLOS in PACU) is a combination of risk factors and complications that can compromise quality of care and operating room efficiency. Our study aimed to develop a nomogram to predict PLOS in PACU of patients undergoing elective surgery.

METHODS

Data from 24017 patients were collected. Least absolute shrinkage and selection operator (LASSO) was used to screen variables. A logistic regression model was built on variables determined by a combined method of forward selection and backward elimination. Nomogram was designed with the model. The nomogram performance was evaluated with the area under the receiver operating characteristic curve (AUC) for discrimination, calibration plot for consistency between predictions and actuality, and decision curve analysis (DCA) for clinical application value.

RESULTS

A nomogram was established based on the selected ten variables, including age, BMI < 21 kg/m2, American society of Anesthesiologists Physical Status (ASA), surgery type, chill, delirium, pain, naloxone, operation duration and blood transfusion. The C-index value was 0.773 [95% confidence interval (CI) = 0.765 - 0.781] in the development set and 0.757 (95% CI = 0.744-0.770) in the validation set. The AUC was > 0.75 for the prediction of PLOS in PACU. The calibration curves revealed high consistencies between the predicted and actual probability. The DCA showed that if the threshold probability is over 10% , using the models to predict PLOS in PACU and implement intervention adds more benefit.

CONCLUSIONS

This study presented a nomogram to facilitate individualized prediction of PLOS in PACU for patients undergoing elective surgery.

Body Mass Index Is Not an Independent Factor Associated With Recovery Room Length of Stay for Patients Undergoing Outpatient Surgery

OBJECTIVES

Prolonged recovery time in the postanesthesia care unit (PACU) increases cost and administrative burden of outpatient surgical staff. The primary aim of this study was to determine whether body mass index (BMI) is associated with prolonged recovery in the PACU after outpatient surgery in a freestanding ambulatory surgery center.

METHODS

We retrospectively studied 3 years of surgeries performed at a freestanding ambulatory surgery center. Mixed-effects logistic (for binary outcomes) and linear (for continuous outcomes) regressions were performed, in which the random effect was the surgical procedure. Prolonged PACU length of stay was modeled as a binary variable, that is, stay greater than the third quartile, and as a continuous variable, that is, actual duration of stay in minutes. We reported odds ratio and 95% confidence interval from the logistic regression and estimates with standard errors from the linear regression.

RESULTS

Patients with obesity (BMI ≥ 30 kg/m 2 ) did not demonstrate increased odds for prolonged PACU length of stay (all P > 0.05). Furthermore, BMI-represented as a continuous variable-was not associated with actual PACU length of stay (estimate = 0.05, standard error = 0.06, P = 0.41). No association was found between obesity and PACU length of stay on a subgroup analysis where only patients with obstructive sleep apnea were analyzed.

CONCLUSIONS

There was no association between BMI and PACU length of stay among patients who received outpatient surgery at a freestanding ambulatory surgery center.