Over-night monitoring in intensive care unit and short-term monitoring in post anesthesia care unit costs analysis after elective hepato-pancreatic–biliary surgery: a retrospective study

The post anesthesia care unit (PACU) was introduced to optimize intensive care unit (ICU) bed availability for patients requiring specialized perioperative care, providing comprehensive monitoring during the recovery phase in high-risk surgical patients. However, though several advantages of PACUs have been clearly demonstrated, no previous studies have investigated the overall costs. This retrospective study aimed at comparing the costs of postoperative monitoring in PACU and ICU after elective hepato-pancreatic-biliary (HPB) surgery at our hospital. A retrospective cohort study was conducted between January 2022 and December 2024. The investigations periods were divided according to the institution of PACU at our institution: before (January 1, 2022-May 31, 2023) and after (June 1, 2023-December 31, 2024). Three groups were identified: ICU 1 and 2, including all pt admitted to ICU before and after the institution of PACU, respectively, and PACU, including all pt admitted to PACU. The primary outcome was the cost of monitoring/pt. Secondary outcome was the overall hospital length of stay (LOS). 171 consecutive pt undergoing HPB surgery were included and divided into 49 pt belonging to ICU 1 group, 60 to ICU 2 and 62 to PACU. Multivariable analysis of monitoring cost revealed the following independent predictors: postoperative surveillance in PACU (P < 0.0001), duration of monitoring (P < 0.0001), male gender (P = 0.028) and severity of complications (P = 0.001), the latter resulting the only significant risk factor for prolonged LOS (P < 0.0001). PACU has emerged as a safe and efficient alternative to ICU in the postoperative surveillance of HPB surgical patients, with associated significant cost savings. Further research is required to identify specific criteria addressing the individual needs for postoperative admission to ICU or PACU.