*Assistant Professor, Department of Commu-
nity Health Systems, University of California,
†Assistant Professor of Anesthesia, University
of California, San Francisco
‡Acting Manager, Postanesthesia Care Unit,
UCSF Stanford Health Care, San Francisco
Address reprint requests to Dr. Seago at the
Department of Community Health Systems,
University of California, San Francisco, Box
0608, San Francisco, CA 94143-0608, USA.
Funding provided by the Collaborative Re-
search Group of the UCSF School of Nursing
and the UCSF Medical Center Department
of Nursing, both of San Francisco, CA.
Received for publication December 3, 1997;
revised manuscript accepted for publication
July 14, 1998.
Factors Influencing Stay in the
Postanesthesia Care Unit:
A Prospective Analysis
Jean Ann Seago, PhD, RN,* Sandra Weitz, MD,†
Susan Walczak, BSN, RN‡
Department of Community Health Systems, Department of Anesthesia, University of
California, San Francisco; and Department of Perioperative Services, UCSF Stanford
Health Care, San Francisco, CA
Study Objective: To identify indicators of prolonged length of stay (LOS) in the
postanesthesia care unit (PACU) and to test the following hypotheses: (1) that patient age,
pain medication administration at the time of PACU admission, length of surgery, and
cardiovascular, pulmonary, and pain responses postoperatively predict prolonged PACU
LOS and (2) that cardiovascular and pulmonary symptoms preoperatively predict
cardiovascular and pulmonary symptoms postoperatively.
Design: Prospective, observational analysis.
Setting: PACU of a university teaching hospital.
Patients: 1,067 patients scheduled for surgery with general anesthesia between February
and September 1996, 18 years of age or older.
Measurement and Main Results: 11.2% of the variation in prolonged PACU LOS can
be predicted by age, pain medication at the time of PACU admission, and postoperative
cardiovascular, pulmonary, and pain symptoms. A significant number of patients who did
not report a prior history experienced postoperative cardiovascular and pulmonary
Conclusion: Patient history and postoperative symptoms predict only a small percentage
of prolonged PACU stays. Organizational factors may be a more important predictor of
prolonged PACU stay. Additionally, assessment of cardiovascular and pulmonary history
needs refinement to improve prediction of patient responses postoperatively. © 1998 by
Elsevier Science Inc.
Keywords: Length of stay; postanesthesia care unit; recovery room
Cost containment is imperative within the health care industry. The cost for a
stay in the postanesthesia care unit (PACU) is similar to that in the intensive care
unit (ICU) and is significantly higher than a stay for the same time in a
medical-surgical unit. Although not all investigators agree,
there is the potential
for labor cost savings with a shorter PACU length of stay (LOS) by reducing staff
overtime related to unexpected lengths of stay. Additionally, identifying how
best to schedule procedures to maximize use of the available labor supply may
increase efficiency and reduce costs.
Studies of PACU stay can be grouped into several categories: (1) comparisons
Journal of Clinical Anesthesia 10:579–587, 1998
© 1998 Elsevier Science Inc. All rights reserved. 0952-8180/98/$19.00
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