Do we need a specialization of recovery room according to patient’s surgical profile

Abstract

For economic, fast recovery and processes optimization reasons, patient’s postoperative route is divided, according to illness severity, in 3 levels of care: recovery room (RR), intermediate care service (ICS) and intensive care unit (ICU). Although the existence of RR in Moldova is referred only formally, no hospital in the country has, in fact, such a unit. Consequently, patients are awaked in operating room or in the ICU - both locations are not suitable for this purpose. For these reasons, we decided to analyze postoperative evolution of general surgery and orthopedic surgery patient’s profiles, with the intention to: 1) identify specific patterns of recovery from anesthesia, 2) argue the necessity of opening more specialized recovery rooms, 3) stratify the patients flow to correspondent care levels, according to they postoperative state severity. The general surgery (n=103) and orthopedic (n=103) patient’s postoperative profiles were analyzed for 3 consecutive months of 2009. There were compared: time profiles of patient’s admission and discharge; recovery duration and stabilization of homeostasis in post-operative period; the proportion of patients of mild severity, moderate to severe state in general surgery vs orthopedic surgery groups. Were used statistical tests: t-Student, Chi2 with Yates correction, Kaplan-Meyer curve. A p<0.05 was considered statistically significant. Groups were comparable according to age, body mass, ASA score. The interventions spectrum of general surgery profile included: endoscopic cholecystectomy (32%), colectomy (23%), inguinal hernia repair (17%), hysterectomy (12%), and other interventions (16%); for the orthopedic profile: hip joint replacement (59%), lower limb osteosynthesis (32%), upper limb osteosynthesis (6%), and other interventions (3%), respectively. The timing of discharge from surgical block depending on daily working hours and week-days’ hours were identical for both groups. Surgical vs orthopedic patients were eligible for the route "RR" in 63% vs 20% (Chi2=36, p<0.0001) of cases, for the route "ICS" - 31% vs 71% (Chi2=5.7, p<0.001), and for the route "ICU" - 4% vs 9% (Chi2=1.8, p=0.17). Surgical patients were progressive discharged on the evening of the same operation day, these of the orthopedic group - massive, in the next morning. Conclusions: 1) For both studied patient’s profiles (surgical and orthopedic), it is reasoned the stratification of post operative’s route in RR, ICS and ICU flows; 2) It is argued the need of supplementary specialization of RR for general surgical and orthopedic patient’ profile; 3) Concomitant diseases determined recovery duration for surgical profile patients, and size of intervention - for the orthopedic profile, respectively.