The association of early postoperative desaturation in the operating theatre with hospital discharge to a skilled nursing or long-term care facility

P. Rostin, B. J. Teja, S. Friedrich, S. Shaefi, K. R. Murugappan, S. K. Ramachandran, T. T. Houle, M. Eikermann

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

Abstract

It is unclear which criteria should be used to define readiness for tracheal extubation in the operating theatre. We studied the effects of desaturation in the operating theatre immediately after tracheal extubation on long-term outcomes. Performing a pre-specified, retrospective analysis of 71,025 cases involving previously independent adults undergoing non-cardiac surgery, we evaluated the association between desaturation events (oxygen saturation < 90%) within 10 min of tracheal extubation and adverse discharge (to a skilled nursing facility or long-term care facility). A total of 404 (12.3%) cases with, and 5035 (7.4%) cases without, early postoperative desaturation had an adverse discharge. Early postoperative desaturation was associated with higher odds of being discharged to a nursing facility (adjusted odds ratio 1.36 (95%CI 1.20–1.54); p < 0.001). Increased duration of desaturation augmented the effect (p for trend < 0.001). Desaturation was associated with a higher risk of respiratory, renal and cardiovascular complications as well as increased duration of hospital stay, postoperative intensive care unit admission frequency and cost. Several modifiable factors were associated with desaturation including: high intra-operative long-acting opioid administration; high neostigmine dose; high intra-operative inspired oxygen concentration; and low oxygen delivery immediately before tracheal extubation. There was substantial provider variability between anaesthetists in the incidence of postoperative desaturation unexplained by patient- and procedure-related factors. Early postoperative desaturation is a potentially preventable complication associated with a higher risk of adverse discharge disposition. Anaesthetists may consider developing guidelines to define tracheal extubation readiness that contain postoperative desaturation as an adverse outcome after tracheal extubation.

Original languageEnglish (US)
Pages (from-to)457-467
Number of pages11
JournalAnaesthesia
Volume74
Issue number4
DOIs
StatePublished - Apr 2019
Externally publishedYes

Keywords

  • adverse discharge
  • hypoxaemia
  • observational
  • postoperative complications
  • tracheal extubation criteria

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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