Factors Associated With Prolonged-Stay Patients Within the Post-anesthesia Care Unit: A Cohort Retrospective Study

The post-anesthesia care unit (PACU) plays a crucial role in providing specialized care to postoperative patients. However, a subset of these patients experiences complications that result in a prolonged stay of 90 minutes or more in the PACU. This not only impacts the patient's quality of life but also disrupts hospital workflow, as it might cause postoperative pain, nausea, or vomiting. It is essential to identify the factors contributing to this prolonged length of stay (LOS) and explore strategies for its prevention and management.  Methods: We conducted a retrospective cohort study of postoperative patients between 2020 and 2021. We included patients who had a prolonged stay, excluding cardiac patients, patients who had a planned prolonged stay, and patients waiting for an intensive care unit bed. We used a non-probability consecutive sampling technique. Data were obtained from the BestCare System, the hospital's information system, using a data collection sheet.

A total of 15,170 patients underwent surgical procedures during the study period, out of which only 181 (1.19%) experienced a prolonged PACU stay. Pain and altered mental status were strongly associated with a prolonged PACU stay (P = 0.035 and P = 0.0009, respectively). However, there was no significant association between overall comorbidities and prolonged LOS in the PACU, except for patients with asthma (P = 0.003). Different types and durations of surgeries did not significantly contribute to a prolonged PACU stay.

Our study found that among the various variables examined, asthma, pain, and altered mental status were significantly associated with a prolonged LOS in the PACU. These findings suggest that targeted interventions addressing these factors may help reduce the incidence of prolonged PACU stays and optimize patient outcomes.