Abstract
Introduction
Patients with ovarian cancer who undergo multivisceral surgery usually require intensive
care monitoring postoperatively. In view of the ever-fewer numbers of high-care/intensive
care
beds and the introduction of fast-track treatment concepts, it is increasingly being
suggested that these patients should be cared for postoperatively in 24-h Post Anesthesia
Care Units
(PACU24). No analyses have been carried out to date to investigate whether such a
postoperative care concept might be associated with a potential increase in postoperative
complications in
this patient cohort.
Methods
A PACU24 unit was set up in our institution in 2015 and it has become the primary
postoperative care pathway for patients with ovarian cancer who have undergone cytoreductive
(debulking)
surgery. A structured, retrospective analysis of data from patients treated before
(control group) and after (PACU group) the introduction of this care concept was carried out, with
a particular focus on postoperative complications and secondary admission to an intensive
care unit where necessary.
Results
The data of 42 patients were analyzed for the PACU group and 45 patients for the control
group. According to the analysis, the preoperative and surgical data of both groups
were
comparable (age, ASA, BMI, FIGO stage, duration of surgery, blood loss). The Physiological
and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM
score) as a
measure for the risk of postoperative complications was higher in the PACU group (11.1%
vs. 9.7%, p = 0.001). Patients in the PACU group underwent bowel resection with anastomosis
significantly more often (76.3% vs. 33.3%, p < 0.001), although the extent of surgery
was otherwise comparable. The total number, type and severity of postoperative complications
and
the duration of the overall stay in hospital did not differ between the two groups.
None of the patients required secondary transfer from the PACU or normal ward to an
intensive care unit
(ICU).
Summary
Our data support the assumption that the care concept of transferring patients to
a PACU24 represents a safe and cost-saving care pathway for the postoperative care
of patients even after
complex gynecological-oncological procedures.
Keywords
Post-Anesthesia Care Unit (PACU24) - fast track - length of hospital stay (LOS) -
cytoreductive surgery - ovarian cancer
