Less-healthy patients more prone to recovery room complications

Complications in the recovery room decreased by 58 percent between 1990 and 2010, according to a study presented at the ANESTHESIOLOGY™ 2013 annual meeting. In a previous study completed in the late 1980s, recovery room complications occurred in 23.7 percent of the patients. Today, the complication rate is 9.9 percent. The study also found that less-healthy patients are more prone to recovery room complications.

As physicians and medical specialists, physician anesthesiologists have been on the forefront of innovations in patient safety for decades. In the 1980s, the American Society of Anesthesiologists (ASA) established a standing committee on patient safety and became the first medical specialty society to formally champion the cause. In 1985, ASA founded the Anesthesia Patient Safety Foundation (APSF).

"Patient safety is a major concern of every person on the surgical team," said Susan M. Dabu-Bondoc, M.D., assistant professor of anesthesiology, Yale University School of Medicine, New Haven, Conn. "For the physician anesthesiologist, anticipation, timely recognition and early management of medical concerns that arise in the immediate postoperative period should prevent complications. A thorough preoperative assessment of the patient's characteristics, judicious anesthetic planning and knowledge of the nature of the procedure remain equally valuable in reducing risks of complications in the post-anesthetic unit."

More than 191,000 consecutive surgical cases of 107,671 unique patients who were treated between 1990 and 2010 were reviewed by Yale University School of Medicine researchers to assess overall complication rates in the recovery room. This survey was compared to a smaller study completed between October 1986 and June 1989 measuring the same data.

The study found that the overall recovery room complication rate decreased substantially to 9.9 percent from 23.7 percent, while the combined PACU and intraoperative complication rate decreased from 26.7 percent to 14.8 percent. Complications shifted from healthier patients (ASA Physical Status Classification System I and II) to patients with moderate to severe systemic diseases (ASA Physical Status Classification System III and IV). Additionally, the study found that women had a significantly higher complication rate of 11.4 percent compared to the 9.3 percent rate in men.

Postoperative nausea and vomiting remained the most common complications in this study, as they were in the previous study. All major complications dropped significantly. The study also found that general anesthesia had a higher complication rate of 13.3 percent compared to the rate of all other anesthetics such as epidural, spinal and nerve blocks at 4.1 percent.