Anandan Dhivyaa, Zhao Shilin, Whigham Amy S
Vanderbilt University College of Arts and Sciences, Nashville, TN, USA.
Surgical Outcomes Center for Kids, Vanderbilt University Medical Center, Nashville, TN, USA.
Ann Otol Rhinol Laryngol. 2020 Nov;129(11):1071-1077. doi: 10.1177/0003489420931557. Epub 2020 Jun 2.
(1) To identify clinical factors and perioperative practices that correlate with longer length of stay (LOS) in the post-anesthesia care unit (PACU) after adenotonsillectomy (T&A) in pediatric populations.(2) To understand the relationship between family presence and PACU LOS for pediatric patients after T&A.
Pediatric patients (ages 3-17) who underwent T&A between February 2016 and December 2016 were retrospectively reviewed. Factors assessed for impact on PACU LOS included BMI, preoperative medications, intraoperative medications/narcotics, postoperative medications/narcotics, method of postoperative medication administration, and family presence in the PACU. Kruskal-Wallis and Spearman tests were used to assess correlations. Statistical significance was set at < .05.
Our cohort included 500 patients. Patients were in the PACU for an average of 135.4 minutes (±65.8). Subset analyses of the type of medications administered intra-operatively and in the PACU show that the intraoperative administration of sedatives is associated with increased LOS ( = .014). Postoperative administration of any medications ( < .001), and specifically, postoperative administration of narcotics ( < .001), analgesics ( = .043), antihistamines ( < .001), and dopamine antagonists ( = .011), are associated with increased LOS. Administration of PACU medications by IV was also correlated with shorter LOS compared to oral administration of PACU medications ( = .016). A comparison of patients who received PACU medications to those who did not demonstrated that intraoperative administration of acetaminophen was associated with a reduced need for PACU medication administration ( = .012). Shorter waiting times for family arrival in the PACU was also associated with shorter LOS ( < .001).
Our results suggest that postoperative medication administration and time until family arrival in the PACU are associated with significant differences in LOS. We also find that intraoperative administration of acetaminophen is correlated with reduced need for postoperative medication administration. Standardizing postoperative practices to minimize PACU LOS could result in a more efficient recovery for pediatric patients undergoing T&A.
（1）确定与小儿腺样体扁桃体切除术（T&A）后在麻醉后恢复室（PACU）停留时间延长相关的临床因素和围手术期操作。（2）了解小儿T&A患者家属在场与PACU停留时间之间的关系。
回顾性分析2016年2月至2016年12月期间接受T&A的3至17岁小儿患者。评估对PACU停留时间有影响的因素包括体重指数（BMI）、术前用药、术中用药/麻醉药、术后用药/麻醉药、术后用药给药方式以及PACU中家属在场情况。采用Kruskal-Wallis和Spearman检验评估相关性。设定统计学显著性水平为<0.05。
我们的队列包括500例患者。患者在PACU的平均停留时间为135.4分钟（±65.8）。对术中及PACU中所用药物类型的亚组分析表明，术中使用镇静剂与停留时间延长相关（P = 0.014）。术后使用任何药物（P < 0.001），特别是术后使用麻醉药（P < 0.001）、镇痛药（P = 0.043）、抗组胺药（P < 0.001）和多巴胺拮抗剂（P = 0.011），均与停留时间延长相关。与口服PACU药物相比，静脉注射PACU药物也与较短的停留时间相关（P = 0.016）。将接受PACU药物治疗的患者与未接受治疗的患者进行比较，结果表明术中使用对乙酰氨基酚与减少PACU药物治疗需求相关（P = 0.012）。家属到达PACU的等待时间较短也与较短的停留时间相关（P < 0.001）。
我们的结果表明，术后用药及家属到达PACU的时间与停留时间的显著差异相关。我们还发现术中使用对乙酰氨基酚与减少术后用药需求相关。规范术后操作以尽量缩短PACU停留时间可能会使接受T&A的小儿患者恢复得更高效。
