PACU Bypass after Outpatient Knee Surgery Is Associated with Fewer Unplanned Hospital Admissions but More Phase II Nursing Interventions

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Abstract
Background: The authors recently proposed a recovery scoring system for outpatients receiving regional anesthesia (RA) or general anesthesia (GA). This scoring system was designed to allow qualifying patients to be directly routed to the phase II (step-down) recovery unit instead of the traditional postanesthesia care unit (PACU). We report PACU bypass rates using these criteria, and the extent to which PACU bypass was associated with (1) required nursing interventions in the step-down recovery unit, and (2) successful same-day discharge. Methods: Day-of-surgery outcomes were studied for 894 outpatients undergoing outpatient sports medicine surgery on the lower extremity. We determined PACU-bypass rates, nursing interventions in the step-down recovery unit for common symptoms, and unplanned hospital admissions. Using logistic regression, we analyzed step-down nursing interventions based on PACU requirement versus PACU bypass, and anesthesia techniques used (GA vs. not, peripheral nerve blocks vs. not). Results: Eighty-seven percent (778/894) of all patients bypassed PACU. Of PACU-bypass patients, 241/778 (31%) required step-down nursing interventions. Of patients requiring PACU, only 19/116 (16%) required additional interventions in step-down (P < 0.001). PACU-bypass patients were almost three times more likely (odds ratio 2.9,P < 0.001) to require at least one nursing intervention in the step-down unit, when compared with patients requiring PACU. Fewer unplanned admissions were required by patients who bypassed PACU (odds ratio = 0.3,P = 0.007). Conclusions: For outpatient lower extremity surgery, applying our PACU-bypass criteria led to an 87% PACU bypass rate with no reportable adverse events.