Perioperative medicine & outcomes
Development and validation of an instrument to predict prolonged length of stay in the postanesthesia care unit following ambulatory surgery
Authors' 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.
Study context
- Population
- Patients receiving anaesthesia care in ambulatory surgery centres
- Participants
- 183,711 vs 148,105
- Comparison
- Development and internal validation vs Validation
- Development and internal validationn = 183,711
- Validationn = 148,105
- Outcome
- Prolonged postanesthesia care unit length of stay (PACU-LOS) (more than four hours) after ambulatory surgery
Methodological detailsretrospective registry, external validation, stepwise backwards elimination
- Retrospective registry
- External validation
- Stepwise backwards elimination
Performance
As reported in the abstract
AUC, development cohort
0.82
95% CI 0.82 to 0.83
AUC, internal validation cohort
0.82
95% CI 0.81 to 0.83
AUC, external validation cohort
0.80
95% CI 0.79 to 0.80
Further findings
Predicted risk of PACU stay past 8 p.m., afternoon cases, ASRI ≥ 43 vs low scores
- ASRI ≥ 43
- 32% (95% CI, 31.1 to 33.3)
- Low score values
- 8% (95% CI, 7.9 to 8.5)
- P-for-interaction < 0.001
Direct PACU cost of care, ASRI ≥ 43 (afternoon cases)
- Higher direct PACU cost
- USD 207 (95% CI, 194 to 2,019)
- Model estimate
- 1.68 (95% CI, 1.64 to 1.73; P < 0.001)
PACU use efficiency
- Effects of using ASRI greater in a free-standing ASC with no limitations on PACU bed availability
Original publication
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