Source | Intervention | Mortality | Other key results |
Callaghan et al9 | Introduction of overnight intensive recovery | No significant difference between groups. Overall in hospital mortality was 2%. fewer than predicted patients died (observed mortality 3 vs predicted 95% CI 8 to 21). | Morbidity: No significant difference between groups. Overall, fever than predicted patients experienced one or more complications (observed 101 vs predicted morbidity 103%–125% 95% CI) Hospital length of stay: No significant difference between groups |
Eichenberger et al10 | Introduction of a two-track clinical pathway that clearly defined and coordinated medical and nursing interventions. | Overall in-hospital mortality decreased significantly from 68 patients (1.5%) to 39 patients (0.8%) (p<0.001). In ASA 3–5 patients, mortality was nearly halved (adjusted OR 0.40) (p<0.001). | Unplanned ICU admission: Total number of unplanned ICU admissions after stay in PACU decreased from 113 (2.5%) to 90 (1.9%) (adjusted OR 0.70) (p=0.70) PACU length of stay: After adjustment for differenced in patients and procedures. Statistically significant decrease in PACU length of stay for ASA 1–2 patients (adjusted p<0.001). There was no difference for ASA 3–5 patients (adjusted p=0.768) |
Fraser and Nair13 | Opening of an extended recovery unit. | Not investigated | Discharge destination after extended recovery unit admission: Data from the first 119 patients admitted to the extended recovery unit were collected. 76 patients (63.9%) who would have otherwise gone to critical care were able to go back to the ward. |
Kastrup et al11 | Introduction of 24 hours intensivist coverage in PACU | No difference between groups | Hospital length of stay: Overall length of stay decreased significantly for all surgical patients. From 8.3 (±11.8) days to 7.71 (±10.99) days. PACU length of stay: More patients were treated in the PACU for a longer period of time. Mean LOS increased from 0.27 (±0.2) days to 0.45 (±0.41) days Cases treated in ICU: Mean number of cases treated in the ICU per month decreased significantly from 164.7 (±14.37) to 133.8 (±19.42) (p=<0.001) ICU treatment days: Mean number of treatment days per month did not change. Relative number of patients with longer LOS (>7 days) increased after introduction of PACU, whereas average number of patients staying <24 hours in the ICU decreased by ~50%. |
Schweizer et al14 | Opening of a new PACU | No difference between study periods | Morbidity: Vascular patients had decreased rates of myocardial infarction (6.4% vs 1.3% p=0.009) and decreased rates of pulmonary oedema (5.1% vs 1.7% p=0.08) Reoperation: No difference between study periods Hospital length of stay: Total hospital length of stay did not change over time |
Street et al15 | Implementation of a Postanaesthesia Care Tool (PACT) | No significant difference between groups. | Patient management in PACU: More requests for medical review 19% vs 30% (p=<0.001), more patients with MET criteria modified by an anaesthetist 6.5% vs 13.8% (p<0.001), higher rates of analgesia administration37.3% vs 54.2% (p=0.001). Adverse events in PACU: More adverse events recorded in PACU in phase 2, 29.4% vs 21.2% (p<0.001). May represent a greater recognition of adverse events in PACU after implementation of PACT. Adverse events after PACU: Significant decrease in rates of clinical deterioration and significant decrease in cardiovascular events after PACU discharge. PACU length of stay: Increase in median PACU length of stay from 45 min in phase 1 to 53 min in phase 2 (p<0.001) |
Tayrose et al12 | Rapid rehabilitation pilot programme where the first two cases of the day were mobilised in the recovery room. | Not investigated | Overall hospital length of stay: Rapid rehabilitation had significantly decreased length of stay that patient who began therapy on postoperative day 1 (p<0.001). Hip arthroplasty subgroup length of stay: Decreased length of stay for rapid rehab patients in the hip arthroplasty subgroup (p<0.001). Knee arthroplasty subgroup length of stay: Decreased LOS for rapid rehab patients in the knee arthroplasty subgroup (p=0.16). |
Zoremba et al16 | Patients performed incentive spirometry in the PACU. | Not investigated | Pulse oximetry: Significantly improved pulse oximetry values at 1 and 2 hours in PACU, and at 6 hours postmobilisations (p<0.0001), and significant improvement in pulse oximetry values at 24 hours postoperative (p<0.0001). Spirometry results: Incentive spirometry group recovered lung function faster in during the PACU stay (p<0.0001). Lung function had almost reached baseline at 6 hours in the incentive spirometry group, however, the control group were up to 25% below baseline (p<0.0001). Overall difference in lung function between groups had decreased 24 hours after surgery, but significant differences still remained (p=0.0040). |
ASA, American Society of Anaesthesiologists physical status classification; ICU, intensive care unit; LOS, Length of stay; MET, Medical emergency team; PACU, postanaesthesia care unit.