Meta-analysis of risk factors associated with postoperative hypoxemia in the postanesthesia care unit.

Objective: To identify the risk factors associated with postoperative hypoxemia in the postanesthesia care unit (PACU), providing evidence-based recommendations for its prevention.

Methods: Observational studies examining the risk factors for postoperative hypoxemia in PACU patients were systematically searched in PubMed, Embase, Cochrane Library, and Web of Science databases from their inception to June 2024. Two independent reviewers screened the literature, extracted data, and assessed the quality of the studies. Meta-analysis was performed using RevMan 5.3 software, employing fixed or random effects models to calculate odds ratios (OR), relative risks (RR), and 95% confidence intervals (CI).

Results: A total of 11 studies were included, comprising 8 cohort studies, 2 case-control studies, and 1 cross-sectional study, with a total of 24,147 subjects, of whom 5,587 experienced hypoxemia. The meta-analysis identified the following significant risk factors for postoperative hypoxemia in the PACU: Advanced age (OR=1.19, 95% CI: 1.11-1.29, P<0.001); Elevated body mass index (BMI) (OR=1.64, 95% CI: 1.36-1.97, P<0.001); Low preoperative oxygen saturation (OR=3.16, 95% CI: 2.56-3.91, P<0.001); Smoking status (OR=1.67, 95% CI: 1.15-2.43, P<0.05); Surgery duration >120 minutes (OR=1.43, 95% CI: 1.22-1.69, P<0.001); Opioid analgesic use (OR=1.51, 95% CI: 1.31-1.74, P<0.001).

Conclusion: These findings highlight the need for targeted preventive strategies in patients at high risk for postoperative hypoxemia in the PACU.