Poster Presentation: Postoperative Sedation on General Care Wards: A Retrospective Cohort Study-Postoperative Sedation on General Care Wards: A Retrospective Cohort Study

Postoperative Sedation on General Care Wards: A Retrospective Cohort Study

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A retrospective cohort study at Mayo Clinic Hospital investigated the incidence, clinical factors, and outcomes of residual postoperative sedation in patients discharged from the Post Anesthesia Care Unit (PACU) to general care wards. Conducted from May 2018 to December 2020, the study reviewed 23,766 cases of adult patients undergoing surgery requiring anesthesia. Patients were classified based on their sedation levels, using the Richmond Agitation Sedation Scale (RASS), into those who were sedated (RASS ≤ -2) and those who were not (RASS -1) in the first 24 hours post-anesthesia.<br /><br />Key findings included:<br />- 4.8% of patients (1,131 patients) experienced residual sedation on the ward.<br />- Ward sedation was associated with specific perioperative characteristics: longer surgical duration, higher intravenous fluid administration, use of gabapentinoids, and general surgical procedures.<br />- Patient factors like female sex, low BMI, diabetes mellitus, and renal disease were also linked to higher sedation rates.<br />- A significant proportion (50%) of sedation cases occurred within 32 minutes of PACU discharge.<br />- Sedation in PACU strongly predicted ward sedation, with higher RASS scores indicating greater risk.<br /><br />Moreover, sedated patients showed dramatically higher rates of clinical decompensation, including emergency interventions, naloxone administration, non-cardiac hypotension, and surgical emergencies. Sedated patients had longer hospital stays and higher mortality rates both in-hospital and within 30 days post-procedure.<br /><br />The study underscores the importance of thorough evaluation before PACU discharge, as patients deeply sedated in PACU are at heightened risk of postoperative complications. It suggests that earlier detection and management of sedation in PACU could significantly improve patient outcomes, noting the need for heightened awareness and potentially extended PACU durations for at-risk patients to mitigate postoperative complications. The limitations point to the need for protocol standardization and further research to generalize the findings across different clinical settings.

Keywords

retrospective cohort study

Mayo Clinic Hospital

postoperative sedation

Post Anesthesia Care Unit

Richmond Agitation Sedation Scale

perioperative characteristics

clinical decompensation

PACU discharge

patient outcomes

protocol standardization