| Part Ⅰ Risk factor of post-anesthesia care unit length of stay in elderly patients with painless gastrointestinal endoscopyBackground With the improvement of China’s medical standard and the increase in ageing,the number of elderly patients undergoing painless gastrointestinal endoscopy is increasing.Due to their own pathophysiological characteristics,the elderly population has a higher incidence and severity of postoperative adverse events and more factors affecting postoperative resuscitation.Painless gastroscopy is also characterised by a large number of outpatients,rapid turnaround and patients leaving the treatment environment for a short period of time.Therefore,to shorten the PACU stay and improve the quality and speed of anesthesia resuscitation is not only in line with the concept of accelerated rehabilitation surgery,but also a necessary requirement to improve the quality of anesthesia for painless endoscopy in the elderly patient population.However,there is a lack of research on the factors influencing the duration of PACU stay after painless gastroenteroscopy in elderly patients.In this study,a crosssectional clinical study was conducted on elderly patients undergoing painless gastroenteroscopy to investigate the independent influencing factors of PACU retention time and to provide a scientific and theoretical basis for improving clinical work.Objective To identify the risk factor of post-anesthesia care unit(PACU)stay in elderly patients with painless gastrointestinal endoscopy.Which is very important to prevent or shorten the time spent in the PACU after painless gastrointestinal endoscopy,improve the quality and speed of patient recovery from anesthesia and ensure the operation and efficiency of endoscopy.Methods The elderly patients received painless gastrointestinal endoscopy from March to June 2021 in our hospital were included in this study,including 537 males and 476 females.The questionnaire was completed by the methods such as preoperative interview,intraoperative and postoperative situation recording to collect information on the patient’s general condition,current and past illness history,intraoperative conditions,and conditions in the PACU.Stepwise regression and multivariable logistic regression analysis was used to identify the independent variables.Based on the interquartile range of anesthesia recovery for the cohort,patients in the upper quartile were categorized as prolonged group and the lowest three quartiles as no-prolonged group.Results The length of stay in the PACU was 257 patients in group D with a mean stay of 27(23～31.5)min,and 716 patients in group N with a mean stay of 13(9～16)min.Compared with group N,group D had increased proportion of preoperative frailty,smoking,intraoperative hypotension,hypotension、sleepiness、dizziness during the PACU(P<0.05).Binary logistic regression analysis showed that preoperative frailty(OR=1.815,95%CI 1.163～2.831),smoking(OR=1.686,95%CI 1.199～2.371),intraoperative hypotension(OR=1.476,95%CI 1.080～2.017),hypotension(OR=1.400,95%CI 1.039～1.888)、sleepiness(OR=1.422,95%CI 1.018～1.987)、dizziness(OR=1.791,95%CI 1.1109～2.892)during the PACU were independent risk factors for prolonged PACU stay.Conclusion Preoperative frailty,smoking,intraoperative hypotension,hypotension、sleepiness、 dizziness during the PACU can delay PACU stay in elderly patients with painless gastrointestinal endoscopy.Part Ⅱ Development and validation of a predictive model for PACU hypotension in elderly patients with painless gastrointestinal endoscopyBackground With the development of comfort care and the increasing ageing in China,more and more elderly people are opting for painless gastroenterology consultation.And propofol is currently the most commonly used sedative in China because of its rapid action,strong sedative effect,short half-life,rapid recovery and high patient satisfaction.However,gastrointestinal gastroscopy consultations are relatively short and intraoperative and postoperative hypotension is often overlooked or undetected.Studies have shown that hypotension is the most common sedation-related complication in patients sedated with propofol,especially in older patients,and is associated with poor prognosis,prolonged discharge from hospital and reduced quality of survival.For the safety and comfort of the patient,it is clinically important to identify risk factors early before the gastroenteroscopy consultation to help the surgeon intervene proactively in advance and to analysis the risk of hypotension.To date,studies to develop and validate predictive models for perioperative hypotension have focused on the intraoperative period.And intraoperative hypotension has repeatedly been shown to be associated with postoperative adverse events.Notably,the large burden of organ dysfunction and mortality resulting from perioperative hypotensive events occurs mainly in the early postoperative period,especially when monitoring intensity is reduced in the PACU resulting in delays or omissions.Therefore,this study proposes to screen risk factors for PACU hypotension in elderly patients undergoing painless gastroenteroscopy by applying Lasso regression and Logistic regression,and use them to construct and validate a line graph model for predicting the risk of developing PACU hypotension,aiming to provide a reference for early clinical identification of people at risk of PACU hypotension.Objective To explore the related risk factors of PACU hypotension in elderly patients with painless gastrointestinal endoscopy,and a nomogram model to predict the risk of PACU hypotension was established and validated based on the results.Methods A total of 973 elderly patients received painless gastrointestinal endoscopy from March to June 2021 in our hospital,including 537 males and 476 females,were divided into the PACU hypotension group and the non-hypotension according to whether hypotension occurred during the PACU.The Lasso model was used to screen the clinical variables related to PACU hypotension,and the independent risk factors was identified by multivariate logistic regression analysis,so as to establish a nomogram model to predict the risk of PACU hypotension based on the results.The discriminative ability,calibration ability and accuracy of the model were evaluated by calibration curve and receiver operating characteristic(ROC)curve,respectively.And the clinical practicability of the model was determined by decision curve analysis(DCA).Results PACU hypotension occurred in 46(38.8%)patients.Multivariate logistic regression analysis showed that age,preoperative water abstinence,intraoperative MAP <65 mm Hg,and decreased intraoperative SBP were independent risk factors for hypotension in the PACU,use of Norepinephrine(NE)was as protective factor.The nomogram model establishment based on the results was validated.The area under the ROC curve(AUC)was 0.710(95% confidence interval [C l 0.672 ~ 0.748)in training set.The area under the ROC curve was 0.778(95% Cl 0.720 ~ 0.837)in validation set.In training and validation sets,the calibration curves were tested by HosmerLemeshow good of fit test,the P values were 0.590 and 0.950,respectively.The DCA curve showed that the nomogram could be applied clinically if the risk threshold was between 20 and 82%,which was found to be between 18 and 92% in the external validation.Conclusion Increasing age,prolonged preoperative water abstinence,decreased intraoperative SBP,intraoperative MAP <65 mm Hg were independent risk factors for hypotension in the PACU,NE was as protective factor.and the nomogram model established based on such results shows visually and individually predict the risk of PACU hypotension. |
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