A postoperative visit reveals a significant number of complications undetected in the PACU

Abstract Study objective To determine whether a postoperative visit (POV) detects significant perioperative complications that are undetected in the PACU discharge note (PDN). Design Retrospective comparison of PDN and POV notes over a 348 day period. Setting PACU and patients’ hospital rooms. Patients The study population included 15,992 adult surgical inpatients discharged from the PACU directly to their hospital rooms following surgery and had postoperative visits between July 2012 and June 2013. Cardiac, obstetrical and Day Surgery patients were excluded since they had they separate postoperative checks by their respective services. Interventions A POV Service performed a POV within 24 h. of PACU discharge on 93% of all eligible inpatients. Measurements. Comparison of PDNs and POV notes of patients who had significant complications noted in the POV. Main results Excluding PONV, the number of significant perioperative complications noted at the POV was small, 145 out of 15,992=0.91%. 100 of these 145=69.0%, were not noted in the PDN, meaning that, on the average, 1 in every 160 (15,992/100) patients discharged from the PACU to the nursing floor had a significant complication of some type, either undetected in the PACU or developing within 24 h. Some, such as cardiac, were picked up most of the time in the PACU, whereas others, e.g., postoperative neuropathies, were missed most of the time. Conclusions Almost 70% of significant complications detected by a postoperative visit were either missed or not apparent in the PACU.