Newly Published
Perioperative Medicine  |   April 2017
Safety Aspects of Postanesthesia Care Unit Discharge without Motor Function Assessment after Spinal Anesthesia: A Randomized, Multicenter, Semiblinded, Noninferiority, Controlled Trial
Author Notes
  • From the Lundbeck Foundation Centre for Fast-Track Hip and Knee Replacement, Copenhagen University Hospital, Rigshospitalet, Copenhagen (E.K.A., C.C.J., M.B.L., J.M., S.S., M.K., P.K.-A., H.M., T.B.H., J.U.N., N.K., A.E.S., H.K.); Section for Surgical Pathophysiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen (E.K.A., C.C.J., H.K.); Department of Orthopedic Surgery, Aalborg University Hospital, Farsø (M.B.L.); Department of Anesthesia and Intensive Care, Aalborg University Hospital, Farsø (J.M.); Department of Orthopedic Surgery, Copenhagen University Hospital Gentofte, Hellerup (S.S.); Department of Anesthesia and Intensive Care, Copenhagen University Hospital Gentofte, Hellerup (M.K.); Department of Orthopedic Surgery (P.K.-A.), and Department of Anesthesia and Intensive Care (H.M.), Vejle Hospital, Vejle; Department of Orthopedic Surgery, Holstebro Regional Hospital, Holstebro (T.B.H.); Department of Anesthesia and Intensive Care, Holstebro Regional Hospital, Holstebro (J.U.N.); Department of Orthopedic Surgery (N.K.), and Department of Anesthesia and Intensive Care (A.E.S.), Viborg Regional Hospital, Viborg, Denmark.
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Submitted for publication September 7, 2016. Accepted for publication February 9, 2017.
    Submitted for publication September 7, 2016. Accepted for publication February 9, 2017.×
  • Acknowledgments: The authors thanks research nurses Ulla Hornum, R.N., Department of Orthopedic Surgery, Aalborg University Hospital, Farsø, Denmark; Heidi Wede, R.N., Department of Orthopedic Surgery, Copenhagen University Hospital Gentofte, Hellerup, Denmark; Susanne Høvsgaard Jung, R.N., Department of Orthopedic Surgery, Vejle Hospital, Vejle, Denmark; Jette Kjærgaard, R.N., Department of Orthopedic Surgery, Holstebro Regional Hospital, Holstebro, Denmark; and Andrea Marie Søe-Larsen, R.N., Department of Orthopedic Surgery, Viborg Regional Hospital, Viborg, Denmark, for their huge efforts and dedication in collecting data and ensuring the quality of the study.
    Acknowledgments: The authors thanks research nurses Ulla Hornum, R.N., Department of Orthopedic Surgery, Aalborg University Hospital, Farsø, Denmark; Heidi Wede, R.N., Department of Orthopedic Surgery, Copenhagen University Hospital Gentofte, Hellerup, Denmark; Susanne Høvsgaard Jung, R.N., Department of Orthopedic Surgery, Vejle Hospital, Vejle, Denmark; Jette Kjærgaard, R.N., Department of Orthopedic Surgery, Holstebro Regional Hospital, Holstebro, Denmark; and Andrea Marie Søe-Larsen, R.N., Department of Orthopedic Surgery, Viborg Regional Hospital, Viborg, Denmark, for their huge efforts and dedication in collecting data and ensuring the quality of the study.×
  • Research Support: This study was funded by the Lundbeck Foundation Centre for Fast-Track Hip and Knee Replacement, Copenhagen, Denmark.
    Research Support: This study was funded by the Lundbeck Foundation Centre for Fast-Track Hip and Knee Replacement, Copenhagen, Denmark.×
  • Competing Interests: The authors declare no competing interests.
    Competing Interests: The authors declare no competing interests.×
  • Reproducible Science: Full protocol available at: eske.kvanner.aasvang.01@regionh.dk. Raw data available at: eske.kvanner.aasvang.01@regionh.dk.
    Reproducible Science: Full protocol available at: eske.kvanner.aasvang.01@regionh.dk. Raw data available at: eske.kvanner.aasvang.01@regionh.dk.×
  • Correspondence: Address correspondence to Dr. Aasvang: Section for Surgical Pathophysiology, 7621, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. eske.kvanner.aasvang.01@regionh.dk. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Central and Peripheral Nervous Systems / Regional Anesthesia
Perioperative Medicine   |   April 2017
Safety Aspects of Postanesthesia Care Unit Discharge without Motor Function Assessment after Spinal Anesthesia: A Randomized, Multicenter, Semiblinded, Noninferiority, Controlled Trial
Anesthesiology Newly Published on April 13, 2017. doi:10.1097/ALN.0000000000001629
Anesthesiology Newly Published on April 13, 2017. doi:10.1097/ALN.0000000000001629
Abstract

Background: Postanesthesia care unit (PACU) discharge without observation of lower limb motor function after spinal anesthesia has been suggested to significantly 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. The 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). The 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 first 24 h 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 nonsignificant tendency toward increased adverse events during the first 24 h in the ward was discovered, further safety data are needed in patients without assessment of lower limb motor function before PACU discharge.