Bypassing PACU after hip, knee arthroplasties

Editor's Note

This prospective Danish study finds that transfer to a postanesthesia care unit (PACU) immediately after elective hip and knee arthroplasty might be unnecessary in low-risk patients.

A total of 696 total knee (274), total hip (287), and unicompartmental knee (135) arthroplasty patients were analyzed. Of those, 307 bypassed the PACU and were admitted directly to the patient ward, and 389 were admitted to the PACU.

Adverse events occurred in both groups, but only two in each group happened within the first 2 postoperative hours, which is the time in most instances that a patient would normally have been discharged from the PACU.

Only one patient was readmitted to the PACU from the patient ward, which was detected and treated rapidly, suggesting that discharge criteria were safe.

The criteria included:

• ASA physical status less than 3
• perioperative bleeding less than 500 mL
• low postoperative discharge score (modified Aldrete-score)
• uncomplicated surgical and neuraxial anesthesia procedure.

The researchers concluded that the use of simple pragmatic criteria for bypassing the PACU in patients having knee and hip arthroplasty procedures with spinal anesthesia is possible and associated with significant reduction of PACU admissions, without apparent safety issues.