title: The Need for a Step-up in Postoperative Medical Care is Predictable in Orthopedic Patients Undergoing Elective Surgery.
abstract: BACKGROUND
  The goal of elective orthopedic surgery is to return patients to their expected level of activity without an increased incidence of postoperative complications. The first step is identifying patient and/or surgical characteristics responsible for these complications.
  
  
  OBJECTIVE
  This study sought to identify predictors of a step-up in medical care after non-ambulatory elective orthopedic surgery.
  
  
  METHODS
  At a single specialty orthopedic hospital, we identified all in-hospital postoperative patients who were transferred to a higher level of medical care ((PACU) post-anesthesia care unit). The characteristics of both transferred and non-transferred patients were compared. A model was built which incorporated predictors of return to a higher level of care.
  
  
  RESULTS
  During a 1-year period, 155 of 7967 patients (1.95%) required transfer to the PACU within 5 days of surgery. Cardiac complications were the major reason for transfer (50.3%), followed by pulmonary (11.0%) and neurological complications (9.7%). Patients who returned to the PACU were older, had more Exlihauser comorbidities, and had obstructive sleep apnea (OSA). In a model adjusting for all patient characteristics: age, American Society of Anesthesiologists (ASA) status, congestive heart failure (CHF), the Charlson comorbidity index and OSA predicted return to the PACU.
  
  
  CONCLUSIONS
  In an elderly population with multiple comorbidities undergoing elective common major orthopedic procedures, approximately 2% of patients required readmission to the PACU. The most common problems requiring this step-up in care were cardiac and pulmonary, which resulted in an increased length of hospital stay. Patients with OSA and multiple comorbidities undergoing total knee arthroplasty carry an increased risk for postoperative complications.
authors: Department of Anesthesiology, Hospital for Special Surgery, 535 East 70th Street, New York, NY USA.
authors: Michael K
authors: MK
authors: Urban
authors: Department of Anesthesiology, Hospital for Special Surgery, 535 East 70th Street, New York, NY USA.
authors: Michele
authors: M
authors: Mangini-Vendel
authors: Department of Epidemology and Biostatistics Core, Hospital for Special Surgery, 535 East 70th Street, New York, NY USA.
authors: Stephen
authors: S
authors: Lyman
authors: Department of Epidemology and Biostatistics Core, Hospital for Special Surgery, 535 East 70th Street, New York, NY USA.
authors: Ting Jung
authors: TJ
authors: Pan
authors: Department of Rheumatology, Hospital for Special Surgery, 535 East 70th Street, New York, NY USA.
authors: Steven K
authors: SK
authors: Magid
keywords: Charlson comorbidity index; Exlihauser comorbidity index; obstructive sleep apnea; post-anesthesia care unit; total knee arthroplasty