Safety aspects of postanesthesia care unit discharge without motor function assessment after spinal anesthesia: a randomized, multicenter, semiblinded, noninferiority, controlled trial

Eske Kvanner Aasvang; Christoffer Calov Jørgensen; Mogens Berg Laursen; Jacob Madsen; Søren Solgaard; Mogens Krøigaard; Per Kjærsgaard-Andersen; Hans Mandøe; Torben Bæk Hansen; Jørgen Ulrich Nielsen; Niels Krarup; Annette Elisabeth Skøtt; Henrik Kehlet

doi:10.1097/ALN.0000000000001629

Safety aspects of postanesthesia care unit discharge without motor function assessment after spinal anesthesia: a randomized, multicenter, semiblinded, noninferiority, controlled trial

Eske Kvanner Aasvang^*, Christoffer Calov Jørgensen, Mogens Berg Laursen, Jacob Madsen, Søren Solgaard, Mogens Krøigaard, Per Kjærsgaard-Andersen, Hans Mandøe, Torben Bæk Hansen, Jørgen Ulrich Nielsen, Niels Krarup, Annette Elisabeth Skøtt, Henrik Kehlet

^*Corresponding author af dette arbejde

Institut for Klinisk Medicin

6 Citationer (Scopus)

Abstract

Background: Postanesthesia care unit (PACU) discharge without observation of lower limb motor function after spinal anesthesia has been suggested to signifcantly reduce PACU stay and enhance resource optimization and early rehabilitation but without enough data to allow clinical recommendations. Methods: A multicenter, semiblinded, noninferiority randomized controlled trial of discharge from the PACU with or without assessment of lower limb motor function after elective total hip or knee arthroplasty under spinal anesthesia was undertaken. Te primary outcome was frequency of a successful fast-track course (length of stay 4 days or less and no 30-day readmission). Noninferiority would be declared if the odds ratio (OR) for a successful fast-track course was no worse for those patients receiving no motor function assessment versus those patients receiving motor function assessment by OR = 0.68. Results: A total of 1,359 patients (98.8% follow-up) were available for analysis (93% American Society of Anesthesiologists class 1 to 2). Te primary outcome occurred in 92.2% and 92.0%, corresponding to no motor function assessment being noninferior to motor function assessment with OR 0.97 (95% CI, 0.70 to 1.35). Adverse events in the ward during the frst 24h occurred in 5.8% versus 7.4% with or without motor function assessment, respectively (OR, 0.77; 95% CI, 0.5 to 1.19, P = 0.24). Conclusions: PACU discharge without assessment of lower limb motor function after spinal anesthesia for total hip or knee arthroplasty was noninferior to motor function assessment in achieving length of stay 4 days or less or 30-day readmissions. Because a nonsignifcant tendency toward increased adverse events during the frst 24h in the ward was discovered, further safety data are needed in patients without assessment of lower limb motor function before PACU discharge.

Originalsprog	Engelsk
Tidsskrift	Anesthesiology
Vol/bind	126
Udgave nummer	6
Sider (fra-til)	1043-1052
Antal sider	10
ISSN	0003-3022
DOI	https://doi.org/10.1097/ALN.0000000000001629
Status	Udgivet - 2017

Adgang til dokumentet

10.1097/ALN.0000000000001629

Citationsformater

Aasvang, E. K., Jørgensen, C. C., Laursen, M. B., Madsen, J., Solgaard, S., Krøigaard, M., Kjærsgaard-Andersen, P., Mandøe, H., Hansen, T. B., Nielsen, J. U., Krarup, N., Skøtt, A. E., & Kehlet, H. (2017). Safety aspects of postanesthesia care unit discharge without motor function assessment after spinal anesthesia: a randomized, multicenter, semiblinded, noninferiority, controlled trial. Anesthesiology, 126(6), 1043-1052. https://doi.org/10.1097/ALN.0000000000001629

Safety aspects of postanesthesia care unit discharge without motor function assessment after spinal anesthesia: a randomized, multicenter, semiblinded, noninferiority, controlled trial. / Aasvang, Eske Kvanner; Jørgensen, Christoffer Calov; Laursen, Mogens Berg et al.
I: Anesthesiology, Bind 126, Nr. 6, 2017, s. 1043-1052.

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

Aasvang, EK, Jørgensen, CC, Laursen, MB, Madsen, J, Solgaard, S, Krøigaard, M, Kjærsgaard-Andersen, P, Mandøe, H, Hansen, TB, Nielsen, JU, Krarup, N, Skøtt, AE & Kehlet, H 2017, 'Safety aspects of postanesthesia care unit discharge without motor function assessment after spinal anesthesia: a randomized, multicenter, semiblinded, noninferiority, controlled trial', Anesthesiology, bind 126, nr. 6, s. 1043-1052. https://doi.org/10.1097/ALN.0000000000001629

@article{d0659ec8da294faf836354d195147f04,

title = "Safety aspects of postanesthesia care unit discharge without motor function assessment after spinal anesthesia: a randomized, multicenter, semiblinded, noninferiority, controlled trial",

abstract = "Background: Postanesthesia care unit (PACU) discharge without observation of lower limb motor function after spinal anesthesia has been suggested to signifcantly reduce PACU stay and enhance resource optimization and early rehabilitation but without enough data to allow clinical recommendations. Methods: A multicenter, semiblinded, noninferiority randomized controlled trial of discharge from the PACU with or without assessment of lower limb motor function after elective total hip or knee arthroplasty under spinal anesthesia was undertaken. Te primary outcome was frequency of a successful fast-track course (length of stay 4 days or less and no 30-day readmission). Noninferiority would be declared if the odds ratio (OR) for a successful fast-track course was no worse for those patients receiving no motor function assessment versus those patients receiving motor function assessment by OR = 0.68. Results: A total of 1,359 patients (98.8% follow-up) were available for analysis (93% American Society of Anesthesiologists class 1 to 2). Te primary outcome occurred in 92.2% and 92.0%, corresponding to no motor function assessment being noninferior to motor function assessment with OR 0.97 (95% CI, 0.70 to 1.35). Adverse events in the ward during the frst 24h occurred in 5.8% versus 7.4% with or without motor function assessment, respectively (OR, 0.77; 95% CI, 0.5 to 1.19, P = 0.24). Conclusions: PACU discharge without assessment of lower limb motor function after spinal anesthesia for total hip or knee arthroplasty was noninferior to motor function assessment in achieving length of stay 4 days or less or 30-day readmissions. Because a nonsignifcant tendency toward increased adverse events during the frst 24h in the ward was discovered, further safety data are needed in patients without assessment of lower limb motor function before PACU discharge.",

author = "Aasvang, {Eske Kvanner} and J{\o}rgensen, {Christoffer Calov} and Laursen, {Mogens Berg} and Jacob Madsen and S{\o}ren Solgaard and Mogens Kr{\o}igaard and Per Kj{\ae}rsgaard-Andersen and Hans Mand{\o}e and Hansen, {Torben B{\ae}k} and Nielsen, {J{\o}rgen Ulrich} and Niels Krarup and Sk{\o}tt, {Annette Elisabeth} and Henrik Kehlet",

year = "2017",

doi = "10.1097/ALN.0000000000001629",

language = "English",

volume = "126",

pages = "1043--1052",

journal = "Anesthesiology",

issn = "0003-3022",

publisher = "Lippincott Williams & Wilkins",

number = "6",

}

TY - JOUR

T1 - Safety aspects of postanesthesia care unit discharge without motor function assessment after spinal anesthesia

T2 - a randomized, multicenter, semiblinded, noninferiority, controlled trial

AU - Aasvang, Eske Kvanner

AU - Jørgensen, Christoffer Calov

AU - Laursen, Mogens Berg

AU - Madsen, Jacob

AU - Solgaard, Søren

AU - Krøigaard, Mogens

AU - Kjærsgaard-Andersen, Per

AU - Mandøe, Hans

AU - Hansen, Torben Bæk

AU - Nielsen, Jørgen Ulrich

AU - Krarup, Niels

AU - Skøtt, Annette Elisabeth

AU - Kehlet, Henrik

PY - 2017

Y1 - 2017

N2 - Background: Postanesthesia care unit (PACU) discharge without observation of lower limb motor function after spinal anesthesia has been suggested to signifcantly reduce PACU stay and enhance resource optimization and early rehabilitation but without enough data to allow clinical recommendations. Methods: A multicenter, semiblinded, noninferiority randomized controlled trial of discharge from the PACU with or without assessment of lower limb motor function after elective total hip or knee arthroplasty under spinal anesthesia was undertaken. Te primary outcome was frequency of a successful fast-track course (length of stay 4 days or less and no 30-day readmission). Noninferiority would be declared if the odds ratio (OR) for a successful fast-track course was no worse for those patients receiving no motor function assessment versus those patients receiving motor function assessment by OR = 0.68. Results: A total of 1,359 patients (98.8% follow-up) were available for analysis (93% American Society of Anesthesiologists class 1 to 2). Te primary outcome occurred in 92.2% and 92.0%, corresponding to no motor function assessment being noninferior to motor function assessment with OR 0.97 (95% CI, 0.70 to 1.35). Adverse events in the ward during the frst 24h occurred in 5.8% versus 7.4% with or without motor function assessment, respectively (OR, 0.77; 95% CI, 0.5 to 1.19, P = 0.24). Conclusions: PACU discharge without assessment of lower limb motor function after spinal anesthesia for total hip or knee arthroplasty was noninferior to motor function assessment in achieving length of stay 4 days or less or 30-day readmissions. Because a nonsignifcant tendency toward increased adverse events during the frst 24h in the ward was discovered, further safety data are needed in patients without assessment of lower limb motor function before PACU discharge.

AB - Background: Postanesthesia care unit (PACU) discharge without observation of lower limb motor function after spinal anesthesia has been suggested to signifcantly reduce PACU stay and enhance resource optimization and early rehabilitation but without enough data to allow clinical recommendations. Methods: A multicenter, semiblinded, noninferiority randomized controlled trial of discharge from the PACU with or without assessment of lower limb motor function after elective total hip or knee arthroplasty under spinal anesthesia was undertaken. Te primary outcome was frequency of a successful fast-track course (length of stay 4 days or less and no 30-day readmission). Noninferiority would be declared if the odds ratio (OR) for a successful fast-track course was no worse for those patients receiving no motor function assessment versus those patients receiving motor function assessment by OR = 0.68. Results: A total of 1,359 patients (98.8% follow-up) were available for analysis (93% American Society of Anesthesiologists class 1 to 2). Te primary outcome occurred in 92.2% and 92.0%, corresponding to no motor function assessment being noninferior to motor function assessment with OR 0.97 (95% CI, 0.70 to 1.35). Adverse events in the ward during the frst 24h occurred in 5.8% versus 7.4% with or without motor function assessment, respectively (OR, 0.77; 95% CI, 0.5 to 1.19, P = 0.24). Conclusions: PACU discharge without assessment of lower limb motor function after spinal anesthesia for total hip or knee arthroplasty was noninferior to motor function assessment in achieving length of stay 4 days or less or 30-day readmissions. Because a nonsignifcant tendency toward increased adverse events during the frst 24h in the ward was discovered, further safety data are needed in patients without assessment of lower limb motor function before PACU discharge.

U2 - 10.1097/ALN.0000000000001629

DO - 10.1097/ALN.0000000000001629

M3 - Journal article

C2 - 28511195

AN - SCOPUS:85020406099

SN - 0003-3022

VL - 126

SP - 1043

EP - 1052

JO - Anesthesiology

JF - Anesthesiology

IS - 6

ER -

Safety aspects of postanesthesia care unit discharge without motor function assessment after spinal anesthesia: a randomized, multicenter, semiblinded, noninferiority, controlled trial

Abstract

Adgang til dokumentet

Fingeraftryk

Citationsformater