Impact of a PACU bypass protocol on time from surgery completion to ward transfer and safety in patients undergoing spinal anesthesia: a retrospective cohort study

Enhancing operating room (OR) efficiency and patient flow remains a persistent challenge in Japan. While post-anesthesia care units (PACU) are widely recognized as useful and have been routinely established in large hospitals, their implementation in small- and medium-sized hospitals remains limited owing to the costs of staffing and facility expansion. Safety concerns regarding direct ward transfer after surgery have also been raised. Therefore, intermediate PACU operational models feasible in smaller hospitals are needed. This study evaluated the effect of implementing a PACU bypass protocol on postoperative efficiency and patient safety. We retrospectively analyzed patients who underwent elective urological surgery under spinal anesthesia between June 2022 and October 2024. The PACU bypass protocol, implemented in 2023, enables eligible patients to be transferred directly from the OR to the ward when predefined criteria, including stable vital signs, anesthetic level at or below T4, and absence of postoperative symptoms, are met. The primary outcome was the duration from surgical completion to discharge from the PACU. In total, 675 patients were included (214 in 2022, 225 in 2023, and 236 in 2024). The mean PACU stay will significantly decrease from 34 min in 2022 to 19 min in 2023 and 20 min in 2024 (p < 0.05). Two minor adverse events were reported in 2023, and none in 2024. Implementing the PACU bypass protocol significantly reduced the PACU stay without compromising patient safety, thereby enhancing perioperative efficiency. Continued protocol adherence and staff training are essential for sustained improvement.