Characteristics of included studies summary table
| Source | Aim | Study design | Number of arms/groups | Population | Intervention | Comparison group | Outcome measures |
| Callaghan et al9 (n=178) | To determine the safety of introducing non-ICU pathways for selected patients. And evaluate the effect on cost, ICU beds availability and cancellation rates of elective surgery. | Retrospective cohort study. | Intervention group: patients selected for OIR. Comparison group: patients booked for an elective ICU admission. | All patients undergoing elective open aortic surgery between 1 January 1998 and 31 December 2002. | (n=152) Introduction of OIR | (n=26) Elective postoperative ICU bed | In-hospital mortality In-hospital morbidity Postoperative length of stay ICU length of stay |
| Eichenberger et al10 (n=6375) | To assess the impact of a clinical pathway implemented in a postanaesthesia care unit on postoperative outcomes. | Retrospective cohort study based on electronic patient records. | Fast track: nurse driven, ASA 1–2. Slow track: physician driven, ASA 3–5 who have undergone minor or major surgery, or developed postoperative complications. Comparison group: Pre-existing PACU conditions without the clinical pathway. | All elective and non-elective inpatients, who underwent a surgical or endoscopic procedure under anaesthesia during the study period. | (n=3345) Introduction of a two-track clinical pathway that clearly defined and coordinated medical and nursing interventions. | (n=3030) Pre-existing PACU conditions without the clinical pathway. | PACU length of stay In-hospital mortality Unplanned ICU admissions after PACU stay. |
| Fraser and Nair13 (n=119) | To assess if elective surgical patients were stable enough to return to the general ward after a stay in Extended Recovery instead of being routinely admitted to ICU. | Observational cohort study. | One arm. No control group | Elective surgical patients who would have previously been booked for level two care postoperatively. | (n=119) Opening of an extended recovery unit. | Nil | Discharge destination after extended recovery unit admission |
| Kastrup et al11 (n=51 090) | To evaluate the effect of around-the-clock intensivist PACU coverage on the structure of ICU, and to demonstrate the economic effect on the hospital. | Retrospective cohort study. | Intervention group: after the introduction of 24 hours intensivist coverage. Comparison group: prior to introduction of 24 hours intensivist coverage. | All patients undergoing a surgical procedure (adults and children) between 1 January 2008 and 30 April 2011. | (n=26 118) Introduction of 24 hours intensivist coverage in PACU | (n=24 972) Pre-existing PACU with no intensivist coverage | PACU LOS ICU LOS Preoperative days Hospital LOS Casemix index Cost |
| Schweizer et al14 (n=933) | To assess the impact of a new PACU on ICU utilisation, hospital length of stay and complications following major non-cardiac surgery. | Observational cohort study. | Intervention group: after opening of a new PACU. Control group: before opening of the new PACU | Adult patients undergoing abdominal aortic reconstruction or resection of lung cancer during the study periods. | (n=485) Opening of a new PACU (PACT) | (n=448) Pre-existing PACU | Mortality Reoperation Secondary admission to ICU Postoperative complications Hospital LOS |
| Street et al15 (n=1417) | To evaluate whether use of a discharge criteria tool for nursing assessment of patients in PACU would enhance nurses' recognition and response to patients at-risk of deterioration and improve patient outcomes. | Prospective non-randomised pre–post intervention study. | Intervention group: after the implementation of the Postanaesthetic Care Tool (PACT) Comparison group: prior to the implementation of PACT. | All adult patients undergoing elective surgery on days of data collection. | (n=694) Implementation of a PACT | (n=723) Standard PACU care without PACT | Nursing management of symptoms Rates of adverse events Mortality PACU LOS Hospital LOS Health service usage and healthcare costs |
| Tayrose et al12 (n=900) | To address the impact of rapid rehabilitation beginning in the recovery room on length-of-stay after primary hip and knee arthroplasty. | Retrospective cohort study. | Intervention group: rapid rehabilitation group. Comparison group: standard rehabilitation protocol | 900 consecutive hip and knee arthroplasty patients. | (n=331) Rapid rehabilitation pilot programme where the first two cases of the day were mobilised in the recovery room. | (n=569) Remainder of cases received standard rehabilitation protocol starting on the morning of postoperative day one. | Overall hospital LOS Hip arthroplasty subgroup LOS Knee arthroplasty subgroup LOS |
| Zoremba et al16 (n=60) | To evaluate the impact of short-term respiratory physiotherapy during the PACU stay, on postoperative lung function tests and pulse oximetry values in obese adults after minor surgery. | Prospective randomised cohort study | Intervention group: physical therapy treatment group that performed incentive spirometry in the PACU Control group: patients who did not undergo physical therapy | 60 obese adult patients (BMI 30–40) ASA 2–3, scheduled for minor peripheral surgery. | (n=30) Patients performed incentive spirometry in the PACU. | (n=30) Not instructed to do any breathing exercises or spirometry. | Pulse oximetry and spirometry at 1, 2, 6 and 24 hours postoperatively |
ASA, American Society of Anaesthesiologists physical status classification; BMI, body mass index; ICU, intensive care unit; LOS, Length of stay; OIR, overnight intensive recovery; PACU, postanaesthesia care unit.