Beyond discharge score: postoperative care unit nurses' clinical assessments improve postoperative risk stratification: A prospective cohort study.

BACKGROUND

Postoperative complications frequently occur within 24 h of surgery and are challenging to detect early. Tools such as the Modified Aldrete Score (MAS) and National Early Warning Score (NEWS) support postanaesthesia care unit (PACU) discharge decisions; however, their prognostic performance is uncertain. Clinical nurse assessments may offer additional value.

OBJECTIVES

To compare the prognostic performance of MAS, NEWS, and PACU nurse clinical assessments in predicting early postoperative complications (within 72 h of PACU discharge) in high-risk surgical patients.

DESIGN

Prospective, two-centre observational cohort.

SETTING

Conducted in two PACUs in the Capital Region of Denmark.

PATIENTS: Two hundred and forty high-risk adult surgical patients were included after elective or emergency procedures. Complications were defined according to Clavien-Dindo grade II to V. Patients with missing nurse assessments ( n  = 15) were excluded from analyses involving this variable.

MAIN OUTCOME MEASURES: The primary outcome was the prognostic performance of MAS in identifying early postoperative complications. Secondary outcomes included the performance of NEWS and PACU nurse assessments. Early complications were defined as events occurring within 72 h of PACU discharge.

RESULTS

MAS and NEWS showed limited predictive ability (AUC = 0.555 and 0.589, respectively). PACU nurse assessments were significantly associated with early complications (AUC = 0.652, P  = 0.006). Patients rated as 'Potentially unstable' or 'Unstable' had a higher risk despite meeting MAS criteria: odds ratio (OR) = 3.65, 95% confidence interval (CI), 1.53 to 8.76; relative risk (RR) = 0.32, 95% CI, 0.15 to 0.70. The optimal threshold yielded 72.4% sensitivity, 61.2% specificity, 21.6% positive-predictive value (PPV), and 93.8% negative-predictive value (NPV). Early complications were associated with increased risk of subsequent complications: OR = 5.0, 95% CI, 1.8-14.1, P  < 0.001.

CONCLUSIONS

PACU nurse assessments outperformed MAS and NEWS in predicting early postoperative complications. Integrating structured clinical judgment into discharge decisions may enhance risk stratification and safety.

TRIAL REGISTRATION: ClinicalTrials.gov: NCT06013891.