Incidence, risk factors and outcomes of post-anaesthetic complications: A prospective cohort study in Mulago Adult Post-anesthesia Care Unit

Abstract

Abstract Background: Post-anaesthetic complications in the post-anaesthesia care unit (PACU) are common and significantly impact patient outcomes often leading to increased morbidity, prolonged PACU stay, and unplanned ICU admissions whose bed availability is limited. The post-anaesthetic standardised clinical pathway improves the early detection of patients at risk of deterioration for better outcomes. This study sought to determine the incidence, risk factors, and outcomes for post-anaesthetic complications in Mulago National Referral Hospital (MNRH). Method: We conducted a prospective cohort study at MNRH PACU that recruited 370 Adult participants, 18 years and above between June and August 2023. Data was collected with REDCap and exported to STATA 17 for analysis. A modified Poisson generalised linear model (GLM) with standard robust error analysis generated Crude Risk Ratio (CRR) at bivariable and Adjusted Risk Ratio (ARR) at multivariable determined the association between postanaesthetic complication and the risk factors. The association between the complications and outcome was determined by the Fisher Exact test. A 95% confidence interval (CI) was calculated. p‐value < 0.05 was considered as statistically significant. Results: The incidence of post-anaesthetic complications in PACU was 74%, and most (40.8%) of the participants had multiple complications. Hypothermia was encountered frequently at (50.5%), followed by tachycardia at (24.1%) and pain at 16.8%. Multivariable analysis showed that factors associated with post-anaesthesia complications in PACU include; intraoperative complications (hypotension ARR 1.23; 95% CI 1.08-1.41 p=0.003, significant blood loss ARR 1.29; 95% CI 1.09-1.52 p=0.002 & hypoxia ARR 1.38: 95% CI 1.21-1.56 p<0.001), intraoperative opioid use (ARR 1.68; 95% CI 1.15-2.46 p=0.008), and 2-3 hours duration of anaesthesia (ARR 1.35; 95% CI 1.12-1.63 p=0.002). The majority of the participants (98.2%) had favourable outcomes and 1.8% unfavourable outcomes were prolonged PACU stay. Conclusion: Given the high incidence of post-anaesthesia complications, coupled with the identified risk factors, standardising PACU care as per WHO recommendation is crucial. Key strategies include; equipping the PACU to enhance patient monitoring, warming of patients and increasing the PACU nurse-to-patient ratio to 1:2 to manage complications better and improve patient outcomes.