Key result
Higher ASA class linked to ~84% greater risk of PACU complications.
Why the study?
The post-anesthesia care unit is the first site of monitoring after surgery where adverse events can affect safety and prognosis, but their frequency and features were not well quantified.
Cross-Sectional (n=2,025)
No
Nearly half of patients experience PACU complications, primarily pain and hypertension, with risk driven by baseline severity, thoracic surgery, and surgical duration.
High PACU complication rates may prompt risk-stratified monitoring in non-cardiac surgery; cross-sectional data leaves open intervention efficacy.
Background: The post-anesthesia care unit (PACU) is the first site of monitoring after surgery/anesthesia, where adverse events can affect safety and prognosis.Quantifying their frequency and features informs prevention and timely management.Objective: To estimate the frequency and types of immediate postoperative adverse events in the PACU of Centro Médico ABC and identify associated factors.Method: Observational, retrospective, cross-sectional study of consecutive patients admitted to the PACU (February-June 2020).Demographics, surgical type, anesthetic technique, and operationally defined events (eg, pain NRS ≥ 4, hypertension ≥ 20% over baseline, PONV, SpO 2 < 92%) were recorded.Descriptive analyses, χ 2 and Mann-Whitney as appropriate, and binary logistic regression with reference coding and L2 regularization (α = 0.05) were performed.Results: We analyzed 2,025 patients; 45.2% had ≥ 1 event.Most frequent: pain (21.6%) and hypertension (14.3%).In multivariate models: ASA II vs I (OR, 1.28; 95% CI, 1.06-1.55)and ASA III+ vs I (OR, 1.84; 95% CI, 1.30-2.65);thoracic surgery vs general (OR, 3.96; 95% CI, 2.74-5.38);neuraxial vs balanced general anesthesia (OR, 2.70; 95% CI, 1.15-5.24);TIVA vs balanced general (OR, 0.56; 95% CI, 0.37-0.90).Surgical duration, modeled continuously, increased risk (OR, 1.05 per 30 minutes; 95% CI, 1.01-1.09).Model performance: AUC 0.631, Brier 0.22.Conclusions: Nearly half of patients experienced PACU events, chiefly pain and hypertension.Risk increased with higher ASA class, thoracic surgery, and longer duration; TIVA was associated with lower risk.Findings support risk stratification and proactive triage in the PACU.
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Jiménez-Ramos et al. (2026) conducted a cross-sectional in Post-anesthesia care unit (PACU) complications after non-cardiac surgery (n=2,025). ASA III+ classification vs. ASA I classification was evaluated on Presence of at least 1 PACU complication (OR 1.84, 95% CI 1.30-2.65). Nearly half of patients (45.2%) experienced at least one PACU complication, with the risk significantly increased by higher ASA class (OR 1.84 for ASA III+ vs I), thoracic surgery, and longer surgical duration.
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