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Erschienen in: HSS Journal ® 1/2016

01.02.2016 | Original Article

The Need for a Step-up in Postoperative Medical Care is Predictable in Orthopedic Patients Undergoing Elective Surgery

verfasst von: Michael K. Urban, MD, PhD, Michele Mangini-Vendel, ACNP-BC, DNP, Stephen Lyman, PhD, Ting Jung Pan, MPH, Steven K. Magid, MD

Erschienen in: HSS Journal ® | Ausgabe 1/2016

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Abstract

Background

The goal of elective orthopedic surgery is to return patients to their expected level of activity without an increased incidence of postoperative complications. The first step is identifying patient and/or surgical characteristics responsible for these complications.

Questions/Purposes

This study sought to identify predictors of a step-up in medical care after non-ambulatory elective orthopedic surgery.

Methods

At a single specialty orthopedic hospital, we identified all in-hospital postoperative patients who were transferred to a higher level of medical care ((PACU) post-anesthesia care unit). The characteristics of both transferred and non-transferred patients were compared. A model was built which incorporated predictors of return to a higher level of care.

Results

During a 1-year period, 155 of 7967 patients (1.95%) required transfer to the PACU within 5 days of surgery. Cardiac complications were the major reason for transfer (50.3%), followed by pulmonary (11.0%) and neurological complications (9.7%). Patients who returned to the PACU were older, had more Exlihauser comorbidities, and had obstructive sleep apnea (OSA). In a model adjusting for all patient characteristics: age, American Society of Anesthesiologists (ASA) status, congestive heart failure (CHF), the Charlson comorbidity index and OSA predicted return to the PACU.

Conclusions

In an elderly population with multiple comorbidities undergoing elective common major orthopedic procedures, approximately 2% of patients required readmission to the PACU. The most common problems requiring this step-up in care were cardiac and pulmonary, which resulted in an increased length of hospital stay. Patients with OSA and multiple comorbidities undergoing total knee arthroplasty carry an increased risk for postoperative complications.
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Metadaten
Titel
The Need for a Step-up in Postoperative Medical Care is Predictable in Orthopedic Patients Undergoing Elective Surgery
verfasst von
Michael K. Urban, MD, PhD
Michele Mangini-Vendel, ACNP-BC, DNP
Stephen Lyman, PhD
Ting Jung Pan, MPH
Steven K. Magid, MD
Publikationsdatum
01.02.2016
Verlag
Springer US
Erschienen in
HSS Journal ® / Ausgabe 1/2016
Print ISSN: 1556-3316
Elektronische ISSN: 1556-3324
DOI
https://doi.org/10.1007/s11420-015-9467-3

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