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Evaluation of Complication Development in General Surgery Patients Admitted to the Post Anesthesia Care Unit

Year 2022, , 383 - 389, 30.06.2022

Sennur Kula Şahin , Hayriye Deniz Şelimen

https://doi.org/10.33808/clinexphealthsci.892276

Abstract

Objective of the Study: This study was conducted to analyze the development of complications and risk factors in general surgery patients admitted to the Post-Anesthesia Care Unit (PACU).
Method: This prospective and cross-sectional study was performed with 230 patients admitted to the PACU of a university hospital in Istanbul. The data were collected pre- and post-operatively in the PACU using the “Patient Monitoring Form”, which was created by the researcher to track the patient’s descriptive characteristics and development of complication. Percentage, mean, chi-square, Student's t, and logistic regression tests were used for data analysis.
Findings: It was found that most of the patients were female aged between 50-65, with a chronic disease included in the ASA II class, who had undergone a laparoscopic cholecystectomy surgical operation, and had a profile of minimal obesity. The most common complications in the PACU were pain (75.7%), hypothermia (58.7%), nausea-vomiting (30.7%), and hypoxemia (20.0%) respectively. Length or duration of operation (OR:1.05; p=0.001) and age (OR: 1.08; p=0.027) were effective risk factors for development of complication; however, no correlation was found between descriptive characteristics of the patients and development of pain (p=0.023). A positive relationship was found between hypothermia and surgical operations with a duration of more than 120.3 minutes (p=0.001). Additionally, age of 57.8 (p=0.002), BMI of 30.8 (kg/m2; p=0.003), and inclusion in the ASA III/IV group (p=0.001) were significant in relation to hypoxemia.
Conclusion: It was found that pain, hypothermia, nausea-vomiting, and hypoxemia remained the most common complications in the PACU, and age and duration of operation were effective risk factors in the development of complications. Based on these results, it is recommended to identify high risk factors specific to the patient in advance and to increase nursing practices to prevent/reduce complications.

Keywords

Complication, post-anesthesia care unit general surgery nursing care.

References

  • [1] Vimlati L, Gilsanz F, Goldik Z. Quality and safety guidelines of postanesthesia care working party on post anaesthesia care (approved by the European Board and Section of Anaesthesiology, Union Europeenne des Medecins Specialistes). Eur J Anaesthesiol 2009;26(9):715-721.
  • [2] Kiekkas P, Tsekoura V, Aretha D, Samios A, Konstantinou E, Igoumenidis M, Stefanopoulos N, Fligou F. Nurse understaffing is associated with adverse events in postanaesthesia care unit patients. J Clin Nurs 2019;28(11-12):2245-2252.
  • [3] Laporta ML, Sprung J, Weingarten TN. Respiratory depression in the post-anesthesia care unit: Mayo Clinic experience. Bosn J Basic Med Sci 2020;21(2):221-28
  • [4] Barone CP, Pablo CS, Barone GW. Postanesthetic care in the critical care unit. Crit Care Nurse 2004;24(1):38-45.
  • [5] Painter TW, Ludbrook GL. Predicting patients at risk of early postoperative adverse. Anaesth Intensive Care 2014;42(5):649- 656.
  • [6] Ruth HS, Haugen FP, Grove DD. Anesthesia Study Commission; findings of 11 years’ activity. JAMA 1947;35(14):881-884.
  • [7] Goldhill DR. Preventing surgical deaths: Critical care and intensive care outreach services in the postoperative period. Br J Anaesth 2005;95(1):88-94.
  • [8] Morgan EG (2006). Care of the postanesthesia patients. In: Clinical Anesthesiology, 4. ed. New York: The McGrawHiII Companies; 1001 – 1017.
  • [10] Belcher AW, Leung S, Cohen B, Yang D, Mascha E, Turan Alparslan, Saager L, Ruetzler K. Incidence of complications in the post-anesthesia care unit and associated healthcare utilization in patients undergoing non-cardiac surgery requiring neuromuscular blockade 2005–2013: A single center study. J Clin Anesth 2017;43:33-38.
  • [11] Cohen MM, O’Brien-Pallas LL, Copplestone C, Wall R, Porter J, Rose DK. Nursing workload associated with adverse events in the postanesthesia care unit. Anesthesiology 1999;91(6):1882- 1890.
  • [12] Khan NA, Quan H, Bugar JM, Lemaire JB, Brant R, Ghali WA. Association of postoperative complications with hospital costs and length of stay in a tertiary care center. J Gen Intern Med 2006;21(2):177-180.
  • [13] Odom Forren J. Postoperative patient care, Rothrock C (ed):Alexander’s Care of the Patient in Surgery:Mosby, 2007:246-267.
  • [14] Kaplow R. Care of postanesthesia patients. Crit Care Nurse 2010;30(1):60-62.
  • [15] Hines R, Barash PG, Watrous G, O’Connor T. Complications occurring in the postanesthesia care unit: A survey. Anesth Analg 1992;74(4):503-509.
  • [16] Van der Walt JH, Webb RK, Osborne GA, Morgan C, Mackay P. Recovery room incidents in the first 2000 incident reports. Anaesth Intensive Care 1993;21(5):650-652.
  • [17] Kluger MT, Bullock MFM. Recovery room incidents: A review of 419 reports from the Anaesthetic Incident Monitoring Study (AIMS). Anaesthesia 2002;57(11):1060-1066.
  • [18] Tarrac SE. A Description of Intraoperative and postanesthesia complication rates. J Perianesthesia Nurs 2006;21(2):88-96.
  • [19] Popov DCS, de Cássia Giani Peniche A. Nurse interventions and the complications in the post-anesthesia recovery room. Rev da Esc Enferm 2009;43(4):946-954.
  • [20] Yavascaoglu B, Kaya FN, Ozcan B. Retrospective Evaluations of Post-Anesthetic Complications in Adults. Journal of Uludağ University Faculty of Medicine, 2009;35(2):73-78.
  • [21] Turkish Society of Anesthesiology and Reanimation (TARD). Anesthesia practice guidelines preoperative preparation. November, 2015. http://www.tard.org.tr/akademi/?p=kilavuz (Accessed January 05, 2022)
  • [22] Cline, M. E, Herman, J, Shaw, E. R, & Morton, R. D. Standardization of the visual analogue scale. Nursing Research 1992;41(6), 378–380.
  • [23] Eti Aslan. Pain assesment methods. Journal of Cumhuriyet University Nursing High School. 2002;6(1):9-16.
  • [24] Aldrete, J. Antonıo M.D. Kroulık Dmd. A Postanesthetic recovery score. Analgesia Anesth Analg. 1970;49(6):924-934.
  • [25] Murphy GS, Szokol JW, Marymont JH, Greenberg SB, Avram MJ, Vender JS. Residual neuromuscular blockade and critical respiratory events in the postanesthesia care unit. Anesth Analg 2008;107(1):130-137.
  • [26] Zelcer J, Wells DG. Anaesthetic-related recovery room complications. Anaesth Intensive Care 1987;15(2):168-174.
  • [27] M Salman J, N Asfarn S. Recovery room ıncidents. Basrah J Surg 2007;13(1):1-5.
  • [28] Celik S, Ad B. Assesment of anesthesia complications in the university hospital. J Anest Reanim 2011;9(3):166-73.
  • [29] Yüksel S, Uğraş GA. The role of nurses in preventing hypothermia in surgical patients Mersin Univ. J.Health Sciences. 2016;9(2):114-120.
  • [30] Hooper VD, Chard R, Clifford T, Fetzer S, Fossum S, Godden B, Martinez E, Noble K, O’Brien D, Odom-Forren J, Peterson C, Ross J, Wilson L. ASPAN’s Evidence-based clinical practice guideline for the promotion of perioperative normothermia: Second Edition. J Perianesthesia Nurs 2010;25(6):346-365.
  • [31] García PS, Duggan EW, McCullough IL, Lee SC, Fishman D. Postanesthesia care for the elderly patient. Clin Ther 2015;37(12):2651-2665.
  • [32] Tohumat ŞG, Kanan N. Intraoperative care in the elderly. Turkiye Klinikleri J Surg Nurs-Special Topics 2017;3(2):65-72.
  • [33] Tunchinda L, Sukchareon I, Kusumaphanyo C, Suratsunya T, Hintog T, Thienthong S. The Thai anesthesia incident monitoring study (Thai AIMS):An analysis of perioperative complication in geriatric patients. J M Assoc Thai 2010;93(6):698-706.
  • [34] Schittek GA, Michaeli K, Labmayr V, Reinbacher P, Gebauer D, Smigaj J, Janina Gollowitsch J, Rief M, Sampl L, Sandner-Kiesling A. Influence of personalised music and ice-tea options on post operative well-being in the post anaesthesia care unit after general or regional anaesthesia. A pre-post-analysis by means of a questionnaire. Intensive Crit Care Nurs 2020; 63:1-6.
  • [35] Aubrun F, Valade N, Coriat P, Riou B. Predictive factors of severe postoperative pain in the postanesthesia care unit. Anesth Analg 2008;106(5):1535-1541.
  • [36] Fecho K, Miller NR, Merritt SA, Klauber-Demore N, Hultman CS, Blau WS. Acute and persistent postoperative pain after breast surgery. Pain Med 2009;10(4):708-715.
  • [37] Ip HYV, Abrishami A, Peng PWH, Wong J, Chung F. Predictors of postoperative pain and analgesic consumption: A qualitative systematic review. Anesthesiology 2009;111(3):657-677.
  • [38] Eti Aslan F, Kula Şahin S, Secginli S, Bülbüloğlu S. Patient satisfaction with nursing practices about postoperative pain management: A systematic review. Agri 2018;30(3):105-115.
  • [39] Smith CA, Ruth-Sahd L. Reducing the incidence of postoperative nausea and vomiting begins with risk screening: an evaluation of the evidence. J Perianesthesia Nurs 2016;31(2):158-171.
  • [40] Ganter MT, Blumenthal S, Dübendorfer S, Brunnschweiler S, Hofer T, Klaghofer R, Zollinger A, Hofer C.K.The length of stay in the post-anaesthesia care unit correlates with pain intensity, nausea and vomiting on arrival. Perioper Med 2014;3(1):1-9.
  • [41] Leslie K, Myles PS, Chan MTV, Paech M.J, Peyton P, Forbes A, McKenzie D. Risk factors for severe postoperative nausea and vomiting in a randomized trial of nitrous oxide-based vs nitrous oxide-free anaesthesia. Br J Anaesth 2008;101(4):498- 505.
  • [42] Liu S kun, Chen G, Yan B, Huang J, Xu H. Adverse respiratory events increase post-anesthesia care unit stay in china: A 2-year retrospective matched cohort study. Curr Med Sci 2019;39(2):325-329.
  • [43] Uakritdathikarn T, Chongsuvivatwong V, Geater AF, Vasinanukorn M, Thinchana S, Klayna S. Perioperative desaturation and risk factors in general anesthesia. J Med Assoc Thail 2008;91(7):1020-1029.
  • [44] Aust H, Kranke P, Eberhart LHJ, et al. Impact of medical training and clinical experience on the assessment of oxygenation and hypoxaemia after general anaesthesia: an observational study. J Clin Monit Comput 2015;29(3):415-426

Year 2022, , 383 - 389, 30.06.2022

Sennur Kula Şahin , Hayriye Deniz Şelimen

https://doi.org/10.33808/clinexphealthsci.892276

Abstract

References

  • [1] Vimlati L, Gilsanz F, Goldik Z. Quality and safety guidelines of postanesthesia care working party on post anaesthesia care (approved by the European Board and Section of Anaesthesiology, Union Europeenne des Medecins Specialistes). Eur J Anaesthesiol 2009;26(9):715-721.
  • [2] Kiekkas P, Tsekoura V, Aretha D, Samios A, Konstantinou E, Igoumenidis M, Stefanopoulos N, Fligou F. Nurse understaffing is associated with adverse events in postanaesthesia care unit patients. J Clin Nurs 2019;28(11-12):2245-2252.
  • [3] Laporta ML, Sprung J, Weingarten TN. Respiratory depression in the post-anesthesia care unit: Mayo Clinic experience. Bosn J Basic Med Sci 2020;21(2):221-28
  • [4] Barone CP, Pablo CS, Barone GW. Postanesthetic care in the critical care unit. Crit Care Nurse 2004;24(1):38-45.
  • [5] Painter TW, Ludbrook GL. Predicting patients at risk of early postoperative adverse. Anaesth Intensive Care 2014;42(5):649- 656.
  • [6] Ruth HS, Haugen FP, Grove DD. Anesthesia Study Commission; findings of 11 years’ activity. JAMA 1947;35(14):881-884.
  • [7] Goldhill DR. Preventing surgical deaths: Critical care and intensive care outreach services in the postoperative period. Br J Anaesth 2005;95(1):88-94.
  • [8] Morgan EG (2006). Care of the postanesthesia patients. In: Clinical Anesthesiology, 4. ed. New York: The McGrawHiII Companies; 1001 – 1017.
  • [10] Belcher AW, Leung S, Cohen B, Yang D, Mascha E, Turan Alparslan, Saager L, Ruetzler K. Incidence of complications in the post-anesthesia care unit and associated healthcare utilization in patients undergoing non-cardiac surgery requiring neuromuscular blockade 2005–2013: A single center study. J Clin Anesth 2017;43:33-38.
  • [11] Cohen MM, O’Brien-Pallas LL, Copplestone C, Wall R, Porter J, Rose DK. Nursing workload associated with adverse events in the postanesthesia care unit. Anesthesiology 1999;91(6):1882- 1890.
  • [12] Khan NA, Quan H, Bugar JM, Lemaire JB, Brant R, Ghali WA. Association of postoperative complications with hospital costs and length of stay in a tertiary care center. J Gen Intern Med 2006;21(2):177-180.
  • [13] Odom Forren J. Postoperative patient care, Rothrock C (ed):Alexander’s Care of the Patient in Surgery:Mosby, 2007:246-267.
  • [14] Kaplow R. Care of postanesthesia patients. Crit Care Nurse 2010;30(1):60-62.
  • [15] Hines R, Barash PG, Watrous G, O’Connor T. Complications occurring in the postanesthesia care unit: A survey. Anesth Analg 1992;74(4):503-509.
  • [16] Van der Walt JH, Webb RK, Osborne GA, Morgan C, Mackay P. Recovery room incidents in the first 2000 incident reports. Anaesth Intensive Care 1993;21(5):650-652.
  • [17] Kluger MT, Bullock MFM. Recovery room incidents: A review of 419 reports from the Anaesthetic Incident Monitoring Study (AIMS). Anaesthesia 2002;57(11):1060-1066.
  • [18] Tarrac SE. A Description of Intraoperative and postanesthesia complication rates. J Perianesthesia Nurs 2006;21(2):88-96.
  • [19] Popov DCS, de Cássia Giani Peniche A. Nurse interventions and the complications in the post-anesthesia recovery room. Rev da Esc Enferm 2009;43(4):946-954.
  • [20] Yavascaoglu B, Kaya FN, Ozcan B. Retrospective Evaluations of Post-Anesthetic Complications in Adults. Journal of Uludağ University Faculty of Medicine, 2009;35(2):73-78.
  • [21] Turkish Society of Anesthesiology and Reanimation (TARD). Anesthesia practice guidelines preoperative preparation. November, 2015. http://www.tard.org.tr/akademi/?p=kilavuz (Accessed January 05, 2022)
  • [22] Cline, M. E, Herman, J, Shaw, E. R, & Morton, R. D. Standardization of the visual analogue scale. Nursing Research 1992;41(6), 378–380.
  • [23] Eti Aslan. Pain assesment methods. Journal of Cumhuriyet University Nursing High School. 2002;6(1):9-16.
  • [24] Aldrete, J. Antonıo M.D. Kroulık Dmd. A Postanesthetic recovery score. Analgesia Anesth Analg. 1970;49(6):924-934.
  • [25] Murphy GS, Szokol JW, Marymont JH, Greenberg SB, Avram MJ, Vender JS. Residual neuromuscular blockade and critical respiratory events in the postanesthesia care unit. Anesth Analg 2008;107(1):130-137.
  • [26] Zelcer J, Wells DG. Anaesthetic-related recovery room complications. Anaesth Intensive Care 1987;15(2):168-174.
  • [27] M Salman J, N Asfarn S. Recovery room ıncidents. Basrah J Surg 2007;13(1):1-5.
  • [28] Celik S, Ad B. Assesment of anesthesia complications in the university hospital. J Anest Reanim 2011;9(3):166-73.
  • [29] Yüksel S, Uğraş GA. The role of nurses in preventing hypothermia in surgical patients Mersin Univ. J.Health Sciences. 2016;9(2):114-120.
  • [30] Hooper VD, Chard R, Clifford T, Fetzer S, Fossum S, Godden B, Martinez E, Noble K, O’Brien D, Odom-Forren J, Peterson C, Ross J, Wilson L. ASPAN’s Evidence-based clinical practice guideline for the promotion of perioperative normothermia: Second Edition. J Perianesthesia Nurs 2010;25(6):346-365.
  • [31] García PS, Duggan EW, McCullough IL, Lee SC, Fishman D. Postanesthesia care for the elderly patient. Clin Ther 2015;37(12):2651-2665.
  • [32] Tohumat ŞG, Kanan N. Intraoperative care in the elderly. Turkiye Klinikleri J Surg Nurs-Special Topics 2017;3(2):65-72.
  • [33] Tunchinda L, Sukchareon I, Kusumaphanyo C, Suratsunya T, Hintog T, Thienthong S. The Thai anesthesia incident monitoring study (Thai AIMS):An analysis of perioperative complication in geriatric patients. J M Assoc Thai 2010;93(6):698-706.
  • [34] Schittek GA, Michaeli K, Labmayr V, Reinbacher P, Gebauer D, Smigaj J, Janina Gollowitsch J, Rief M, Sampl L, Sandner-Kiesling A. Influence of personalised music and ice-tea options on post operative well-being in the post anaesthesia care unit after general or regional anaesthesia. A pre-post-analysis by means of a questionnaire. Intensive Crit Care Nurs 2020; 63:1-6.
  • [35] Aubrun F, Valade N, Coriat P, Riou B. Predictive factors of severe postoperative pain in the postanesthesia care unit. Anesth Analg 2008;106(5):1535-1541.
  • [36] Fecho K, Miller NR, Merritt SA, Klauber-Demore N, Hultman CS, Blau WS. Acute and persistent postoperative pain after breast surgery. Pain Med 2009;10(4):708-715.
  • [37] Ip HYV, Abrishami A, Peng PWH, Wong J, Chung F. Predictors of postoperative pain and analgesic consumption: A qualitative systematic review. Anesthesiology 2009;111(3):657-677.
  • [38] Eti Aslan F, Kula Şahin S, Secginli S, Bülbüloğlu S. Patient satisfaction with nursing practices about postoperative pain management: A systematic review. Agri 2018;30(3):105-115.
  • [39] Smith CA, Ruth-Sahd L. Reducing the incidence of postoperative nausea and vomiting begins with risk screening: an evaluation of the evidence. J Perianesthesia Nurs 2016;31(2):158-171.
  • [40] Ganter MT, Blumenthal S, Dübendorfer S, Brunnschweiler S, Hofer T, Klaghofer R, Zollinger A, Hofer C.K.The length of stay in the post-anaesthesia care unit correlates with pain intensity, nausea and vomiting on arrival. Perioper Med 2014;3(1):1-9.
  • [41] Leslie K, Myles PS, Chan MTV, Paech M.J, Peyton P, Forbes A, McKenzie D. Risk factors for severe postoperative nausea and vomiting in a randomized trial of nitrous oxide-based vs nitrous oxide-free anaesthesia. Br J Anaesth 2008;101(4):498- 505.
  • [42] Liu S kun, Chen G, Yan B, Huang J, Xu H. Adverse respiratory events increase post-anesthesia care unit stay in china: A 2-year retrospective matched cohort study. Curr Med Sci 2019;39(2):325-329.
  • [43] Uakritdathikarn T, Chongsuvivatwong V, Geater AF, Vasinanukorn M, Thinchana S, Klayna S. Perioperative desaturation and risk factors in general anesthesia. J Med Assoc Thail 2008;91(7):1020-1029.
  • [44] Aust H, Kranke P, Eberhart LHJ, et al. Impact of medical training and clinical experience on the assessment of oxygenation and hypoxaemia after general anaesthesia: an observational study. J Clin Monit Comput 2015;29(3):415-426
There are 43 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Articles
Authors

Sennur Kula Şahin 0000-0002-3939-1382

Hayriye Deniz Şelimen 0000-0002-3533-3628

Publication Date June 30, 2022
Submission Date March 7, 2021
Published in Issue Year 2022

Cite

APA Kula Şahin, S., & Şelimen, H. D. (2022). Evaluation of Complication Development in General Surgery Patients Admitted to the Post Anesthesia Care Unit. Clinical and Experimental Health Sciences, 12(2), 383-389. https://doi.org/10.33808/clinexphealthsci.892276
AMA Kula Şahin S, Şelimen HD. Evaluation of Complication Development in General Surgery Patients Admitted to the Post Anesthesia Care Unit. Clinical and Experimental Health Sciences. June 2022;12(2):383-389. doi:10.33808/clinexphealthsci.892276
Chicago Kula Şahin, Sennur, and Hayriye Deniz Şelimen. “Evaluation of Complication Development in General Surgery Patients Admitted to the Post Anesthesia Care Unit”. Clinical and Experimental Health Sciences 12, no. 2 (June 2022): 383-89. https://doi.org/10.33808/clinexphealthsci.892276.
EndNote Kula Şahin S, Şelimen HD (June 1, 2022) Evaluation of Complication Development in General Surgery Patients Admitted to the Post Anesthesia Care Unit. Clinical and Experimental Health Sciences 12 2 383–389.
IEEE S. Kula Şahin and H. D. Şelimen, “Evaluation of Complication Development in General Surgery Patients Admitted to the Post Anesthesia Care Unit”, Clinical and Experimental Health Sciences, vol. 12, no. 2, pp. 383–389, 2022, doi: 10.33808/clinexphealthsci.892276.
ISNAD Kula Şahin, Sennur - Şelimen, Hayriye Deniz. “Evaluation of Complication Development in General Surgery Patients Admitted to the Post Anesthesia Care Unit”. Clinical and Experimental Health Sciences 12/2 (June 2022), 383-389. https://doi.org/10.33808/clinexphealthsci.892276.
JAMA Kula Şahin S, Şelimen HD. Evaluation of Complication Development in General Surgery Patients Admitted to the Post Anesthesia Care Unit. Clinical and Experimental Health Sciences. 2022;12:383–389.
MLA Kula Şahin, Sennur and Hayriye Deniz Şelimen. “Evaluation of Complication Development in General Surgery Patients Admitted to the Post Anesthesia Care Unit”. Clinical and Experimental Health Sciences, vol. 12, no. 2, 2022, pp. 383-9, doi:10.33808/clinexphealthsci.892276.
Vancouver Kula Şahin S, Şelimen HD. Evaluation of Complication Development in General Surgery Patients Admitted to the Post Anesthesia Care Unit. Clinical and Experimental Health Sciences. 2022;12(2):383-9.

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