In the Postoperative Care Unit surgical patients are monitored closely to ensure safe condition before transfer to the ward. This study will aim to identify patients in risk of complications on the ward using the national postanesthesia care unit (PACU) discharge criteria, a modified Aldretes score. Secondary to identify patients in risk of micro events as detected by continuous monitoring of vital signs on the ward.
Patients undergoing esophageal resection and pancreaticoduodenectomy are at high risk of developing complications after surgery. Described patient groups are monitored for at least 24 hours in PACU before returning to the ward. In Denmark physiological parameters are assessed in the PACU every hour until discharge using the DASAIM discharge criteria (A modified Aldrete score). The PACU discharge score is calculated on parameters including sedation, respiratory rate, saturation, systolic blood pressure, puls, physical capability (if epidural or spinal anesthesia), pain in rest, nausea, diuresis and temperature. Each parameter is given a score between 0 and 3. 0 describes no problem and 3 describes a severe problem. The investigators will investigate the predictive value of the PACU discharge criteria and interventions in the PACU setting, to identify patients at risk of developing postoperative complications. Secondary outcome is micro events on the ward. Patients vital signs are monitored continuously from PACU discharge until the 5th postoperative day. Micro events are defined as deviations of vital parameters from normal range.
Study Type
OBSERVATIONAL
Enrollment
100
* PACU discharge criteria (modified aldrete score). * Continous monitoring of vital signs 96 postoperative hours
Rigshospitalet
Copenhagen, Denmark
Clinical in-hospital complications
Occurence of clinical complications occuring during the hospital stay (pneumonia, myocardial infarction, brain stroke, renal impairment, etc), based upon international definitions
Time frame: until discharge, up to 90 days
Bradycardia
pulse \<40/min measured by pulse oximeter
Time frame: During the first 4 postoperative days
Tachycardia
pulse \>140/min meausured by pulseoximetry
Time frame: During the first 4 postoperative days
Severe desaturation
Arterial saturation \<85% lasting \>10 minutes per episode, measured by pulse oximeter
Time frame: During the first 4 postoperative days
Very severe desaturation
Arterial saturation \<80% lasting \>10 minutes per episode, measured by pulse oximeter
Time frame: During the first 4 postoperative days
Hypotension
Middle arterial blood pressure \<75 for \>29 minutes measured by non-invasive manometer
Time frame: During the first 4 postoperative days
Severe hypotension
Middle arterial blood pressure \<65 for \>29 minutes measured by non-invasive manometer
Time frame: During the first 4 postoperative days
bradypnea
respiratory rate \<8/min for 30 minutes, measured by ECG
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Time frame: During the first 4 postoperative days
Tachypnea
respiratory rate \>20/min for 30 minutes, measured by ECG
Time frame: During the first 4 postoperative days
Severe tachypnea
respiratory rate \>30/min for 30 minutes, measured by ECG
Time frame: During the first 4 postoperative days
Clinical out of hospital complications
Occurence of clinical complications occuring after the hospital stay (pneumonia, myocardial infarction, brain stroke, renal impairment, etc), based upon international definitions
Time frame: until 96 days postoperatively