Risk Factors for Emergence Agitation in the Postanesthesia Care Unit: A Propensity Score–Matched Analysis

Abstract

Purpose: The purpose of this study was to identify predictors of acute emergence agitation (EA) in the postanesthesia care unit (PACU) following general anesthesia and to examine associated risk factors to inform effective management strategies. Design: A single-center retrospective observational study. Methods: We conducted a secondary data analysis of data from 15,667 adult patients who underwent surgery under general anesthesia at a tertiary general hospital in Seoul, Korea. To reduce selection bias and strengthen causal inference, we used propensity score matching at a 1:4 ratio, resulting in a final analysis of 6,620 patients. EA was defined as a Richmond Agitation-Sedation Scale score of greater than or equal to +1. Risk factors were analyzed using binary logistic regression. Findings: The incidence of EA was significantly higher in patients with a pain score of 7 or above compared with those with a score below 3 (odds ratio [OR] = 8.080, P < .001). Patients undergoing procedures in Urology and Gynecology departments were 2.2 times more likely to experience EA than those in other departments such as Otolaryngology, Internal Medicine, Plastic Surgery, and Ophthalmology (OR = 2.171, P < .001). Lower serum albumin levels (OR = 1.582, P < .001) and lower blood glucose levels (OR = 0.996, P < .001) were also associated with a higher incidence of EA. Additional predictors included anesthesia duration longer than 2 hours (OR = 1.496, P < .001), the presence of a urinary catheter (OR = 1.313, P = .007), and undergoing anesthesia for the first time (OR = 1.213, P = .004). Conclusions: Patients who have undergone surgery under general anesthesia and present with the risk factors identified in this study should be regarded as high risk for EA. Nurses in the PACU should identify and effectively manage these patients. © 2025 Elsevier B.V., All rights reserved.