Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology and Intensive Care, University Hospitals of Geneva, Geneva, Switzerland.
Eur J Anaesthesiol. 2011 Dec;28(12):859-66. doi: 10.1097/EJA.0b013e328347dff5.
The immediate post-operative period is critical with regard to post-operative outcomes.
To assess the impact of a clinical pathway implemented in a post-anaesthesia care unit on post-operative outcomes.
A retrospective cohort study based on electronic patient records.
A post-anaesthesia care unit in a Swiss University Hospital.
Adult patients after elective and non-elective surgery.
Implementation of a clinical pathway with a nurse-driven fast-track programme for uncomplicated patients (systematic use of Aldrete score and systematic discharge without physician) and a physician-driven slow-track programme for complicated patients (systematic handover between operating theatre and post-anaesthesia care unit, and between post-anaesthesia care unit and ward, systematic rounds, systematic use of standardised care for post-operative events, strict discharge criteria).
Post-anaesthesia care unit length of stay, in-hospital mortality and unplanned admission to the ICU after post-anaesthesia care unit stay.
Comparison of the periods before and after implementation using median and interquartile range (IQR) and rates (%).
unpaired Student's t-test, χ test, Wilcoxon rank test. Differences were adjusted through multivariate analyses with linear and logistic regression (level of significance: P < 0.05) and expressed as odds ratio (OR) with 95% confidence interval (95% CI).
After implementation, the median post-anaesthesia care unit length of stay decreased for all patients from 163 min (IQR 103-291) to 148 min (IQR 96-270; P < 0.001); in the American Society of Anaesthesiologists 1-2 patients, it decreased from 152 min (IQR 102-249) to 135 min (IQR 91-227; P < 0.001). In-hospital mortality decreased for all patients from 1.7 to 0.9% [adjusted OR 0.36 (95% CI 0.22-0.59), P < 0.001]. The number of unplanned admissions to the ICU decreased from 113 (2.8%) to 91 (2.1%) [adjusted OR 0.73 (95% CI 0.53-0.99), P = 0.04].
A clinical pathway in a post-anaesthesia care unit can significantly reduce length of stay and can improve post-operative outcome.
术后即刻是影响术后结果的关键时期。
评估在麻醉后护理单元实施临床路径对术后结果的影响。
基于电子患者记录的回顾性队列研究。
瑞士大学医院的麻醉后护理单元。
择期和非择期手术后的成年患者。
为非复杂性患者实施护士主导的快速通道计划（系统使用 Aldrete 评分和无需医生即可系统出院）和为复杂性患者实施医生主导的慢速通道计划（手术室和麻醉后护理单元之间、麻醉后护理单元和病房之间的系统交接、系统查房、系统使用标准化术后护理、严格出院标准）。
麻醉后护理单元的住院时间、院内死亡率以及麻醉后护理单元住院后计划外转入 ICU。
使用中位数和四分位距（IQR）和比率（%）比较实施前后的时间段。
未配对学生 t 检验、χ检验、Wilcoxon 秩检验。通过多元线性和逻辑回归分析进行差异调整（显著性水平：P < 0.05），并表示为优势比（OR）及其 95%置信区间（95%CI）。
实施后，所有患者的麻醉后护理单元住院时间中位数从 163 分钟（IQR 103-291）降至 148 分钟（IQR 96-270；P < 0.001）；美国麻醉医师协会 1-2 级患者从 152 分钟（IQR 102-249）降至 135 分钟（IQR 91-227；P < 0.001）。所有患者的院内死亡率从 1.7%降至 0.9%[调整后的 OR 0.36（95%CI 0.22-0.59），P < 0.001]。计划转入 ICU 的患者人数从 113 例（2.8%）降至 91 例（2.1%）[调整后的 OR 0.73（95%CI 0.53-0.99），P = 0.04]。
麻醉后护理单元的临床路径可显著缩短住院时间，并可改善术后结果。
