Incidence of postoperative complications in the major operation room post anesthesia care unit of Tikur Anbessa specialized hospital, 2018
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Date
2018-10
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Addis Ababa University
Abstract
Background: Emergence from anesthesia is the critical period. This early emergence period is
ubiquitous with 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 occur in the 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 continue to be a source of patient
morbidity. The overall incidence of complications occurring during the post anesthesia care unit
stay may be higher than previously expected.
Objectives: To investigate the incidence of postoperative complications among patients
admitted to the PACU at the major operation room in TASH. And to identify factors that are
associated with the complications and to propose an instrument that addresses the
complications, risks and individualized interventions.
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Methodology: After approval from the university, institutional based prospective
cross-sectional study was conducted from June 14- July 29, 2017 to investigate the incidence of
complications in all patients admitted to PACU who had surgery (elective and emergency)
under general anaesthesia (GA), Monitored Anaesthesia Care (MAC), Regional Anaesthesia
(RA). Data was collected using survey data sheet (a standardised data collection form), which is
a three page check-box form and was analyzed using Statistical Package for Social Sciences,
version 21.
Results: During the study period 312 patients were admitted to the PACU of the major OR.
Total number of patients who had complications in the PACU was 65 (20.83%). The type of
complications is characteristically of respiratory system in the first place (35.4%); followed by
cardiovascular system complications (21.1%), and PONV (13.8%) which comes third on the list.
Of all the studied variables only the presence of pre-existing co-morbidity and duration of the
surgery had significant association with the incidence of complications. But none of the 65
patients who had complications was found having any significant correlation to: Age (P=0.714),
Sex (P=0.717), Urgency of procedure (P=0.472), Type of surgery (P=0.887), Type of anesthesia
(P=0.150), Attending anesthesia provider (P=0.378) and Position during surgery (P=0.370)
Conclusion and recommendation: The presence of pre-existing co-morbidity and the longer the
duration of the surgery, the higher the incidence of the post-op complication will be.
There was a very small number of patients in the study, I believe that inclusion of more patients
and different surgical specialties such as Obstetrics and orthopedic surgeries would have
changed the results in terms of kind and percentage of complications. I recommend that a
prospective follow-up trial be undertaken in large number of patients, with data on critical
incidents being collected by clinicians, to strengthen the findings of this study.
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Keywords
Anesthesia; postanesthesia care unit; survey on adverse events.