Role of an enhanced post-anesthesia care unit in postoperative intensive care utilization

Aims: Postoperative intensive care unit (ICU) demand frequently exceeds capacity in high-volume tertiary hospitals. Enhanced post-anesthesia care units (ePACUs) have been proposed as an intermediate level of care providing advanced postoperative monitoring and short-term organ support. This study aimed to evaluate the real-world role of an ePACU in postoperative intensive care management.Methods: This retrospective observational study was conducted at a high-volume tertiary hospital and included all consecutive patients admitted to the ePACU over a 12-month period. Demographic characteristics, surgical specialty, anesthetic technique, presence of a preoperative ICU request, ePACU length of stay, advanced treatments applied and disposition after ePACU observation were evaluated. Results: A total of 180 patients admitted to the ePACU were included. Preoperative ICU admission was requested for 121 patients (67.2%), of whom 20 (16.5%) required ICU admission. Care was provided to 59 patients without a preoperative ICU request, and only 2 of these patients (3.4%) subsequently required ICU admission. In multivariable logistic regression, ASA ≥III status independently predicted ICU admission, whereas age ≥65 years was associated with lower odds (OR 0.26, 95% CI 0.10 -0.72); preoperative ICU request, male sex, and type of anesthesia were not independent predictors. The positive predictive value of preoperative ICU request was low (16.5%), whereas the negative predictive value was high (96.6%). Conclusion: In a high-volume tertiary center, the ePACU functioned as an effective intermediate postoperative care setting, allowing selected patients to be managed without immediate ICU admission. These findings suggest that ePACUs may support more flexible postoperative intensive care management.