Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
Curr Med Sci. 2019 Apr;39(2):325-329. doi: 10.1007/s11596-019-2038-y. Epub 2019 Apr 23.
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.
尽管全球对患者安全的关注度日益提高，但中国尚无关于不良呼吸事件 (AREs) 对麻醉后护理和术后护理影响的数据。本研究评估了 AREs 的发生情况、AREs 对麻醉后护理单元 (PACU) 停留时间和住院后时间的影响，以及 PACU 成本和住院医疗费用。一项回顾性、匹配队列研究通过前瞻性收集了 2016 年至 2017 年期间中国一家大学医院 PACU 中 159 例 ARE 的数据。记录由经过培训的合格护士和/或麻醉师进行审查。分析了 ARE 的发生率和影响。还获得了 PACU 和住院医疗费用的停留时间和住院时间。结果显示，共有 253 例 ARE 涉及 156 例患者。低氧血症 (n=141，55.73%) 和呼吸抑制 (n=70，27.67%) 是最常见的 AREs。测量数据包括体重指数 (BMI) (22.85±4.36 vs. 22.32±3.83)、手术时间 (138.47±77.33 分钟 vs. 137.44±72.33 分钟)、麻醉时间 (176.35±82.66 分钟 vs. 174.61±78.08 分钟)、PACU 停留时间 (16.53±10.65 天 vs. 16.57±9.56 天)、住院医疗费用 ($9465.57±9416.33 vs. $8166.51±5762.01) 和术后 PACU 停留时间 (11.26±8.77 天 vs. 11.19±8.30 天) 在 ARE 组和匹配组之间无显著差异 (P>0.05)。ARE 组的时间 (81.65±54.79 分钟 vs. 38.89±26.09 分钟) 和成本 ($31.99±17.80 vs. $18.72±8.39) 均显著高于匹配组 (P<0.001)。ARE 组在 PACU 中延长停留时间的患者比例明显高于匹配组 (18.59% vs. 1.28%)，匹配后比值比为 17.58 (95%CI=4.11 至 75.10；P<0.001)。PACU 中发生的术后即刻 AREs 增加了延长停留时间的发生率，延长了 PACU 停留时间，并增加了 PACU 成本，导致需要比预期更高水平的术后护理，但术后 PACU 停留时间和住院医疗费用保持不变。
