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Analysis of Adverse Events in the Postanesthesia Unit at a Tertiary Pediatric Hospital
1Department of anesthesia, Post anesthesia care unit, Children's Hospital of Fudan University, Shanghai, China.
Insights
Pediatric postanesthesia care unit (PACU) adverse events are uncommon but linked to longer stays. Young age, higher ASA grade, and general surgery increase risk. Specific surgeries also correlate with distinct adverse events.
Area of Science:
- Pediatric Anesthesiology
- Critical Care Medicine
- Patient Safety
Background:
- The postanesthesia care unit (PACU) is vital for safe anesthesia emergence.
- Adverse events in adult PACU populations are well-documented.
- Pediatric PACU adverse events remain under-investigated.
Purpose of the Study:
- To investigate the incidence, spectrum, and risk factors of adverse events in pediatric patients within a PACU.
- To identify specific surgical procedures associated with increased risk of adverse events.
Main Methods:
- Retrospective observational study of pediatric patients admitted to the PACU.
- Data collected on various adverse events including hypothermia, airway events, and prolonged PACU stay.
- Statistical analyses including t tests and chi-squared tests were performed.
Main Results:
- 1.48% of 16,012 children experienced 305 adverse events.
- Most common events: prolonged PACU stay (8.4%), adverse airway events (5.6%), abnormal temperature (2.7%).
- Younger age, higher ASA grade, and general surgery were independent risk factors for adverse events.
Conclusions:
- This study provides current data on pediatric PACU adverse events at a tertiary hospital.
- Younger patients, higher ASA grades, and general surgery patients face increased PACU adverse event risk.
- Specific surgeries are associated with unique patterns of adverse events.
Purpose:
The postanesthesia care unit (PACU) is an indispensable part of modern medicine which provides critical care to patients to ensure safe and smooth emergence from anesthesia. The adverse events in the PACU have been widely investigated in adults. However, little is known about the adverse events in pediatric populations. This study was designed to investigate adverse events, including the incidence, disease spectrum, and possible risk factors, in pediatric patients in the PACU at a tertiary pediatric hospital.
Design:
This is a retrospective observational study.
Methods:
Children admitted to the PACU at the Children's Hospital of Fudan University from September 2021 to August 2022 were included in the study. The following adverse events were recorded: hypothermia, fever, adverse airway events, hypotension, hypertension, prolonged length of stay in PACU, pain, reintubation, neurological events, unplanned admission to the intensive care unit, arrhythmia, water-electrolyte imbalance, and bleeding requiring medical intervention. Descriptive analyses, t tests, and χ2 tests were performed.
Findings:
A total of 16,012 children were included in the study, and 305 adverse events occurred in 237 (1.48%) children. The three most frequently occurring adverse events were prolonged stay in the PACU (8.4%), adverse airway events (5.6%), and abnormal temperature (2.7%). Age, American Society of Anesthesiologists' grade, and general surgery were independent risk factors of both overall adverse events and prolonged stay in the PACU in multivariate logistic regression analysis. Children with adverse events stayed in the PACU significantly longer than those without adverse events (60.04 ± 1.01 vs 95.8 ± 47.25 minutes, P < .05). Compared with the other surgeries, a significantly higher proportion of severe pain (37.5% vs 0%) after thoracic surgery, prolonged stay in the PACU (52.9% vs 36.4%) after general surgery, and neurological events (14.7% vs 0%) after neurological surgery was detected, while a significantly lower proportion of adverse airway events after general surgery (21.1% vs 43%) and neurological surgery (8.8% vs 43%) was detected, respectively.
Conclusions:
Our study reports the current incidence and spectrum of adverse events in the PACU at a tertiary pediatric hospital. Patients with young age, high American Society of Anesthesiologists' grade, and those from the general surgery department are at a significantly increased risk of adverse events in the PACU. Significant differences were detected in the proportion of specific adverse events after specific surgeries.
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