Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia.
Centre for Integrated Critical Care, University of Melbourne, Melbourne, Australia.
Anaesthesia. 2021 Apr;76(4):480-488. doi: 10.1111/anae.15260. Epub 2020 Oct 7.
Postoperative complications are common and may be under-recognised. It has been suggested that enhanced postoperative care in the recovery room may reduce in-hospital complications in moderate- and high-risk surgical patients. We investigated the feasibility of providing advanced recovery room care for 12-18 h postoperatively in the post-anaesthesia care unit. The primary hypothesis was that a clinical trial of advanced recovery room care was feasible. The secondary hypothesis was that this model may have a sustained impact on postoperative in-hospital and post-discharge events. This was a multicentre, prospective, feasibility before-and-after trial of moderate-risk patients (predicted 30-day mortality of 1-4%) undergoing non-cardiac surgery and who were scheduled for postoperative ward care. Patients were managed using defined assessment checklists and goals of care in an advanced recovery room care setting in the immediate postoperative period. This utilised existing post-anaesthesia care unit infrastructure and staffing, but extended care until the morning of the first postoperative day. The advanced recovery room care trial was deemed feasible, as defined by the recruitment and per protocol management of > 120 patients. However, in a specialised cancer centre, recruitment was slow due to low rates of eligibility according to narrow inclusion criteria. At a rural site, advanced recovery room care could not be commenced due to logistical issues in establishing a new model of care. A definitive randomised controlled trial of advanced recovery room care appears feasible and, based on the indicative data on outcomes, we believe this is warranted.
术后并发症很常见，且可能未被充分识别。有研究表明，在恢复室中加强术后护理，可能会降低中高危手术患者的院内并发症发生率。我们研究了在麻醉后恢复室为术后 12-18 小时提供高级恢复室护理的可行性。主要假设是，高级恢复室护理的临床试验是可行的。次要假设是，这种模式可能对术后院内和出院后事件产生持续影响。这是一项多中心、前瞻性、中危患者（预测术后 30 天死亡率为 1%-4%）的可行性前后试验，这些患者接受非心脏手术，计划在术后病房接受护理。患者在术后即刻的高级恢复室护理环境中，根据既定的评估检查表和护理目标进行管理。这种模式利用了现有的麻醉后恢复单元基础设施和人员配备，但将护理延长到术后第一天的早晨。高级恢复室护理试验被认为是可行的，因为根据定义，招募了>120 名符合方案管理的患者。然而，在一家专门的癌症中心，由于根据严格的纳入标准，符合条件的患者比例较低，招募工作进展缓慢。在农村地区，由于建立新护理模式的后勤问题，无法开始高级恢复室护理。高级恢复室护理的确定性随机对照试验似乎是可行的，并且根据结果的指示性数据，我们认为这是合理的。
