Risk factors for agitation after abdominal surgery under general anesthesia and effectiveness of care risk management

Objective: To investigate the risk factors for postoperative agitation in patients who underwent laparotomy under general anesthesia and to observe the effect of targeted care risk management on prevention of agitation, reduction in care-related adverse events and shortening of hospital stay. Methods: This study was subdivided into two phases. In Phase I, we explored the risk factors for postoperative agitation in patients who underwent laparotomy under general anesthesia. The enrolled subjects were 392 patients undergoing laparotomy in our hospital from January 2013 to November 2014. They were assigned to the case group and the control group in terms of the presence/absence of postoperative agitation. The risk factors for postoperative agitation were evaluated with the use of a chi-square test and the multivariate logistic regression analysis. In Phase II, we examined the effectiveness of care risk management interventions targeting at the above-mentioned risk factors on the rates of postoperative agitation, care-related adverse events as well as length of hospital stay. A total of 199 patients with laparotomy between January 2015 and December 2015 were included in Phase II. Results: In Phase I of the study, among 392 patients, postoperative agitation occurred in 82 patients. In univariate analysis and multivariate logistic regression analysis, an age of 70 years or older (adjusted OR (odds ratio) 2.07, 95% CI: 1.26-3.14), the American Society of Anesthesiologists (ASA) Class 3 or higher (OR 1.74, 95% CI: 1.07-2.51), intravenous-inhalation anesthesia (OR 1.52, 95% CI: 1.02-1.78), postoperative urinary intubation (OR 1.35, 95% CI: 1.02-1.78) and postoperative VAS pain score ≥6 (1.43, 95% CI: 1.08-2.01) were independent risk factors for postoperative agitation in patients who underwent laparotomy. In Phase II, after care risk inventions targeted at the above-mentioned risk factors were conducted, the rate of agitation was reduced to 10.6% (P=0.002), and the rate of associated adverse events dropped from 25.8% to 14.6% (P=0.002). Furthermore, the length of ICU stay and of hospital stay after car risk management were also significantly shorter than those in the conventional care period (P=0.008 and 0.047, respectively). Conclusion: The parameters including an age ≥70, preoperative ASA Class ≥3, intravenous-inhalation anesthesia, postoperative urinary intubation and postoperative VAS pain score ≥6 can significantly increase the risk for postoperative agitation after laparotomy. Besides, the implementation of care risk management is associated with reductions in the rates of postoperative agitation and care risks, and shorter hospital stay as well.