Faculty Collaboration Database

Is regional anesthesia associated with reduced PACU length of stay?: A retrospective analysis from a tertiary medical center. Clin Orthop Relat Res 2014 May;472(5):1427-33

Date

10/22/2013

Pubmed ID

24142300

Pubmed Central ID

PMC3971246

DOI

10.1007/s11999-013-3336-5

Scopus ID

2-s2.0-84899569682 (requires institutional sign-in at Scopus site)   17 Citations

Abstract

BACKGROUND: Postanesthesia care is a costly component of overall surgical care. In the ambulatory setting, regional anesthesia has been shown for multiple surgical procedures to either decrease postanesthesia care unit (PACU) length of stay (LOS) or completely bypass it altogether. This has not been demonstrated in a large hospital setting with a complex surgical case mix.

QUESTIONS/PURPOSES: We therefore determined whether regional anesthesia was associated with a reduced PACU LOS among patients undergoing inpatient and outpatient surgery in a large tertiary-care teaching hospital. Secondary study questions included risk factors for longer PACU LOS and any possible interaction between regional and general anesthesia as it might have affected PACU LOS.

METHODS: We performed a matched retrospective study on patients who had surgery at our institution and were admitted to the PACU immediately after leaving the operating room. We analyzed between January 1, 2005, and January 1, 2013, with one cohort receiving regional anesthesia, with or without general anesthesia, and the other receiving no regional anesthesia. We measured the association between regional anesthesia and time to successful PACU discharge using a Cox multivariate proportional-hazards model.

RESULTS: After controlling for potentially confounding variables, including patient age, American Society of Anesthesiologists' physical classification, and duration of surgery (using multivariate analysis), there was no difference in the time to successful PACU discharge between patients who received regional anesthesia and those who did not. However, when compared to those who received general anesthesia, regional anesthesia was associated with decreased PACU LOS. Further, there was significant effect modification between regional and general anesthesia; patients who received both regional and general were more likely to be successfully discharged faster from the PACU than patients who received only general anesthesia (hazard ratio = 1.50, 95% CI = 1.46-1.55, p < 0.001).

CONCLUSIONS: We demonstrated that independently, regional anesthesia is not associated with a reduced PACU LOS in an unselected population at a large tertiary-care hospital, but regional is favored when compared to general anesthesia. Whether the differences are clinically important, and in what procedures they are most pronounced, would be reasonable questions for future prospective comparative trials.

LEVEL OF EVIDENCE: Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Author List

Corey JM, Bulka CM, Ehrenfeld JM

Author

Jesse Ehrenfeld MD, MPH Sr Associate Dean, Director, Professor in the Advancing a Healthier Wisconsin Endowment department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Anesthesia Recovery Period
Anesthesia, Conduction
Anesthesia, General
Female
Hospitals, Teaching
Humans
Length of Stay
Male
Middle Aged
Multivariate Analysis
Patient Discharge
Proportional Hazards Models
Retrospective Studies
Risk Factors
Surgical Procedures, Operative
Tennessee
Tertiary Care Centers
Time Factors