Prevalence of postoperative complications in postanesthesia Care unit, institutional based cross sectional study at jimma University medical center, jimma, Ethiopia

Abstract

Background: Emergence from anesthesia is a critical period. Theearly emergence period is a time withmany potential complications. In order to enable early detection and prompt treatment of these potential complications by the practitioner, there needs to be an effective system of detection and reporting of all adverse events occurring during the period of emergence. A wide spectrum of critical incidents occurs in the postanesthesia care unit (PACU), many of which are related to the cardiovascular and respiratory systems. Critical incidents have a major impact on healthcare utilization and result in prolonged PACU stays and higher levels of postoperative care than initially anticipated. Events occurring during the PACU period are a source of patient morbidity. The overall incidence of complications occurring during the PACU stay may be higher than previously expected. Objectives: To determine the prevalence of postoperative complications and identify factors associated with those complications among patients admitted to the PACU at the major operation room in Jimma University Medical Center (JUMC). Methods: After approval from the university, institutional based cross-sectional study was conducted from April to July 2020 to investigate the prevalence of complications in postoperative patients admitted to PACU who had surgery (elective and emergency) under general anesthesia (GA), Monitored Anesthesia Care (MAC), or Regional Anesthesia (RA). Patients admitted to ICU either directly from operation room or from PACU were excluded from the study. During the study period, 265 patients were admitted to PACU; of these 255 patients’ data were analyzed. Ten patient’s data were excluded from the analysis due to either due to directly admissions to respective ward due to lack of bed in PACU (seven patients) and missed data of the patients (three patients), and patients who stayed in PACU for administrative reasons,such as awaiting discharge from an occupied bed elsewhere (four patients). Data regarding potential risk factors including patients’ sociodemographics (e.g.age and sex), Americans Society of Anesthesiologists (ASA) physical status, types of surgery, types of anesthesia, position during surgery, attending anesthesia provider, preexisting comorbidities, and duration of anesthesia were analyzed. And, possible PACU complications like cardiovascular, respiratory, central nervous system, gastrointestinal, genitourinary, thermal incidents and otherswas collected using a survey data sheet and was analyzed using SPSS, version 21. III Results: During the study period, from 265 patients admitted to PACU, 255patient’s data were analyzed. Of these, 128(50.2%) had developed complications.The types of complications were characteristically of the cardiovascular system in the first place (41.7%); followed by postoperative nausea and vomiting (40.2%); hypoxia or desaturation (36.2%); pain (28.3%); hypothermia (27.6%); neurological complications (15.7%); urinary retention (11%); and fall from bed (2.4%). Of all the studied variables,ASA physical status (AOR 4.99, 95%CI 1.89, 13.16), types of surgery (AOR 0.48, 95%CI 0.16, 1.45), and duration of anaesthesia(AOR 2.84, 95%CI 1.17, 6.94) had significant association with the incidence of complications. These three variables predict the occurrence of postanesthesia care unit complications. Conclusions and Recommendations: Results from this study show that complications occurring in the PACU remain a significant source of patient morbidity.Particularly, PONV, hypothermia, pain and urinary retention in Jimma university medical center is significantly high as compared to other institutions, which might need much attention to improve the patient’s outcome postoperatively.