Conference Coverage

Higher Initial PACU Pain Linked to Longer Stay in Two-Hospital Study

Edited by:
Ashton L. Stahl

Key Highlights

  • The retrospective study included 3,275 adults at hospitals in Bangkok and New York.
  • Patients with moderate to severe pain on PACU arrival had a median stay of 120 minutes, compared with 95 minutes for those with mild pain.
  • Initial pain severity was not associated with the time to discharge readiness measured by the modified Aldrete score.

Moderate to severe pain on arrival in the post-anesthesia care unit (PACU) was associated with a longer PACU stay in a two-hospital retrospective study of adults undergoing noncardiac surgery. The findings are described in an abstract scheduled for presentation at ANESTHESIOLOGY 2026; the supplied abstract does not identify a publishing journal.

Researchers studied 3,275 adults who underwent noncardiac surgery under general anesthesia and were admitted to the PACU between November 1 and December 31, 2022. The patients received care at 2 university-affiliated hospitals in Bangkok, Thailand, and New York, United States. Researchers classified the first PACU pain score as mild (numeric rating scale score ≤3) or moderate to severe (>3). They examined PACU length of stay and the time until patients first reached a modified Aldrete score of at least 9, their measure of discharge readiness. Multivariable linear regression models adjusted for demographic and clinical confounders.

Study Findings

Overall, 28.7% of patients had moderate to severe pain on PACU arrival. Their median PACU stay was 120 minutes, compared with 95 minutes among patients with mild pain. The adjusted absolute difference was 19.7 minutes (95% CI, 8.44-31.01; P = .001).

The association did not extend to discharge readiness as measured by the modified Aldrete score. The reported time to readiness was 47.5 minutes in the moderate to severe pain group and 59.0 minutes in the mild pain group; the adjusted absolute difference was 0 minutes (95% CI, −3.21 to 3.21; P = 1.000). The abstract also identified age 65 years or older, American Society of Anesthesiologists class 3, gynecologic surgery, and longer anesthesia duration as factors associated with a prolonged PACU stay.

Clinical Implications

According to the study authors, differences between PACU length of stay and Aldrete-based discharge readiness suggest nurses should consider patients’ pain intensity when planning discharge, alongside the score’s indication of readiness. 

Expert Commentary

“Initial pain severity upon PACU arrival was associated with prolonged PACU stay, but was not reflected in the modified Aldrete score based time until PACU discharge readiness,” the researchers concluded.

Reference

Buasuk T, Rojanapithayakorn N, Atisook R, et al. Association between initial post-anesthesia care unit pain severity and PACU length of stay: a multicenter retrospective hospital study. Abstract presented at: ANESTHESIOLOGY 2026; October 16-20, 2026; San Diego, CA. Abstract A2064.