Authors: Hvidberg et al.
Journal: European Journal of Anaesthesiology published: March 10, 2026
Summary:
This prospective cohort study evaluated whether PACU nurse clinical assessments improve prediction of early postoperative complications compared with commonly used discharge and warning scores.
The study included 240 high-risk adult surgical patients at two PACUs in the Capital Region of Denmark. Patients underwent either elective or emergency procedures. The authors compared the Modified Aldrete Score, the National Early Warning Score, and PACU nurse clinical assessments for predicting postoperative complications within 72 hours after PACU discharge.
The primary outcome was the ability of the Modified Aldrete Score to identify early postoperative complications. Complications were defined as Clavien-Dindo grade II to V. Fifteen patients with missing nurse assessments were excluded from analyses involving nurse assessment.
The Modified Aldrete Score and National Early Warning Score had limited predictive ability. The Modified Aldrete Score had an AUC of 0.555, and NEWS had an AUC of 0.589. PACU nurse clinical assessment performed better, with an AUC of 0.652.
Patients rated by nurses as “potentially unstable” or “unstable” had a higher risk of early complications, even when they met Modified Aldrete Score discharge criteria. The optimal nurse-assessment threshold had 72.4% sensitivity, 61.2% specificity, 21.6% positive predictive value, and 93.8% negative predictive value.
The study also found that early postoperative complications were associated with a higher risk of later complications.
Why this matters:
This study supports the idea that structured clinical judgment from experienced PACU nurses may add important safety information beyond numeric discharge scores. Scores such as the Modified Aldrete Score and NEWS may not fully capture subtle concerns about patient stability before transfer from the PACU.
Take-home point:
PACU nurse clinical assessments outperformed the Modified Aldrete Score and NEWS in predicting early postoperative complications. Incorporating structured nurse judgment into PACU discharge decisions may improve postoperative risk stratification and patient safety.
Thank you to the European Journal of Anaesthesiology for publishing this article and allowing us to summarize it.