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Canadian Journal of Anesthesia/Journal canadien d'anesthésie

Erschienen in:

13.11.2023 | Reports of Original Investigations

Development and validation of an instrument to predict prolonged length of stay in the postanesthesia care unit following ambulatory surgery

verfasst von: Samuel Rupp, Elena Ahrens, Maira I. Rudolph, MD, Omid Azimaraghi, MD, Maximilian S. Schaefer, MD, PhD, Philipp Fassbender, MD, Carina P. Himes, MD, Preeti Anand, MD, Parsa Mirhaji, MD, PhD, Richard Smith, MD, Jeffrey Freda, MD, Matthias Eikermann, MD, PhD, Karuna Wongtangman, MD

Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Ausgabe 12/2023

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Abstract

Purpose

We sought to develop and validate an Anticipated Surveillance Requirement Prediction Instrument (ASRI) for prediction of prolonged postanesthesia care unit length of stay (PACU-LOS, more than four hours) after ambulatory surgery.

Methods

We analyzed hospital registry data from patients who received anesthesia care in ambulatory surgery centres (ASCs) of university-affiliated hospital networks in New York, USA (development and internal validation cohort [n = 183,711]) and Massachusetts, USA (validation cohort [n = 148,105]). We used stepwise backwards elimination to create ASRI.

Results

The model showed discriminatory ability in the development, internal, and external validation cohorts with areas under the receiver operating characteristic curve of 0.82 (95% confidence interval [CI], 0.82 to 0.83), 0.82 (95% CI, 0.81 to 0.83), and 0.80 (95% CI, 0.79 to 0.80), respectively. In cases started in the afternoon, ASRI scores ≥ 43 had a total predicted risk for PACU stay past 8 p.m. of 32% (95% CI, 31.1 to 33.3) vs 8% (95% CI, 7.9 to 8.5) compared with low score values (P-for-interaction < 0.001), which translated to a higher direct PACU cost of care of USD 207 (95% CI, 194 to 2,019; model estimate, 1.68; 95% CI, 1.64 to 1.73; P < 0.001) The effects of using the ASRI score on PACU use efficiency were greater in a free-standing ASC with no limitations on PACU bed availability.

Conclusion

We developed and validated a preoperative prediction tool for prolonged PACU-LOS after ambulatory surgery that can be used to guide scheduling in ambulatory surgery to optimize PACU use during normal work hours, particularly in settings without limitation of PACU bed availability.

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Titel: Development and validation of an instrument to predict prolonged length of stay in the postanesthesia care unit following ambulatory surgery
verfasst von: Samuel Rupp
Elena Ahrens
Maira I. Rudolph, MD
Omid Azimaraghi, MD
Maximilian S. Schaefer, MD, PhD
Philipp Fassbender, MD
Carina P. Himes, MD
Preeti Anand, MD
Parsa Mirhaji, MD, PhD
Richard Smith, MD
Jeffrey Freda, MD
Matthias Eikermann, MD, PhD
Karuna Wongtangman, MD
Publikationsdatum: 13.11.2023
Verlag: Springer International Publishing
Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Ausgabe 12/2023
Print ISSN: 0832-610X
Elektronische ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-023-02604-1

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Development and validation of an instrument to predict prolonged length of stay in the postanesthesia care unit following ambulatory surgery