The utilisation of the post-anaesthesia high-care unit at Tygerberg Hospital: a retrospective audit

Abstract

Background: The post-anaesthesia high-care unit (PAHCU) at Tygerberg Hospital is a short-stay high-care unit that provides continuous monitored care to patients identified preoperatively as having an elevated risk for postoperative complications. This study aims to describe the patient population, utilisation, and functionality of this unit and to investigate the correlation between patient comorbidities, surgery type, and risk of exceeding a 24-hour stay.
Methods: This is a retrospective, single-centre descriptive study of 1 020 patients’ data admitted to the PAHCU from 1 January 2019 to 31 December 2020. All patients admitted were included. The primary outcome was the utilisation and functionality of the unit. Secondary outcomes were the indication for admission, modes of analgesia used, and length of stay.
Results: Of the 1 020 patients, 69 (6.76%) patients exceeded the 24-hour stay. In total, 889 (87.2%) were pre-planned admissions and 130 (12.8%) unplanned, one (0.09%) patient demised, and 11 (1.07%) patients were transferred to the ICU for further management. Bed occupancy during weekdays was 86.8% in 2019 and 58.13% in 2020. Patients with aortic stenosis had 4.36 (95% CI 1.23–15.41, p = 0.022) times the odds of exceeding a 24-hour PAHCU stay. Additional significant factors included ages < 40 (p = 0.01) and > 61 (p = 0.006), admission for epidural care (p = 0.015), haemodynamic monitoring (p < 0.001), and patients who were admitted from the general surgery department (p = 0.014).
Conclusion: PAHCU admissions are considered appropriate due to the low mortality rate, ICU transfer rate, and the number of patients exceeding a 24-hour stay. With a bed occupancy of 86.80% in 2019, the management of the unit can be considered effective.