Fast-Track Eligibility and Hospital Discharge for Outpatient Lumbar Discectomy
Condition: Lumbar Disc Disease; Post-Op Complication
MeSH terms: Postoperative Complications
Study type: Observational [Patient Registry]

Summary: 
      122 ASA I-II patients were enrolled into the study. IV propofol, fentanyl and rocuronium were
      used for the induction and a total intravenous anesthesia technique for the maintenance of
      anesthesia. Sugammadex was given for neuromuscular blockade reversal. A multi-modal analgesic
      regimen was utilized. Primary outcome measures were PACU bypass rates and hospital discharge
      times. Secondary outcome measure was to compare discharge scoring systems for PACU bypass
      assessment: modified Aldrete Scoring System (mASS), White's Fast-Tracking Scoring System
      (WFTSS), and SPEEDS criteria
    

Detailed description: 
      After obtaining hospital's ethics committee approval (University of Medical Sciences, Gülhane
      Training and Research Hospital- Date: 06/05/2018; No: 18/148) and written informed consents
      obtained from patients, 122 ASA (American Society of Anesthesiologists) physical status I-II
      patients, aged between 18-65 years, undergoing elective lumbar discectomy under general
      anesthesia were included into the study . After anesthesia application applied to all groups
      with the same procedure, patients were extubated after surgery. After extubation, patients
      were evaluated using mASS, WFTSS and SPEEDS criteria during 15 minutes with 3 min intervals.
      Patients who fulfilled criteria of all scoring systems were defined as eligible for PACU
      by-pass (fast-tracking) and transferred into phase II recovery area in the ward without
      observation in PACU (Group FT = Fast Track;). Ineligible patients were taken into PACU where
      their treatments were continued until discharge criteria were achieved (Group PACU). All
      patients were followed in the ward until hospital discharge. IV tramadol PCA (Patient
      -Controlled Analgesia; infusion rate: 4 mgh-1, bolus dose: 4mg, lock-out time: 30 min., 4
      hours-limit: 30 mg), paracetamol (10 mgkg-1 IV with 6 hrs. intervals) and oral diclofenac
      sodium (75 mg with 8 hrs. intervals) were given in a multimodal analgesic regimen. Pain was
      evaluated using Visual Analogue Scale (VAS) with 2 hours intervals and IV pethidine 0.5
      mgkg-1 was given as rescue analgesic throughout the study period when VAS was >3. PONV was
      treated using IV 4 mg ondansetron. Discharge from hospital was evaluated using Post
      Anesthetic Discharge Scoring System (PADSS), . Patients with a PADSS score ≥ 9 were
      discharged from the hospital by the escort of their relatives.
    

Intervention name(s): Modified Aldrete Scoring System (mASS); White's Fast-Track Scoring System (WFTSS); SPEEDS criteria
Intervention type(s): Other; Other; Other
Intervention description(s): Activity( Moves all extremities, Moves two extremities, Unable to move extremities), Respiration( Breathes deeply, coughs freely, Dyspneic, shallow or limited breathing, Apneic), Circulation (blood pressure) ( 20 mm Hg > preanesthetic level, 20 - 50 mm Hg > preanesthetic level, 50 mm Hg > preanesthetic level), Consciousness (Fully awake, Arousable on calling, Not responding), Oxygen saturation( SpO2 > 92% on room air, Supplemental O2 required to maintain SpO2 > 90%,SpO2 < 90% with O2 supplementation), scoring is done as 2,1,0, respectively. A score of 9 or more would be required for a patient after general anesthesia for discharge; Physical activity (Able to move all extremities on command, ,Some weakness in movement of extremities, Unable to voluntarily move extremities),Respiratory stability(Able to breathe deeply,Tachypnea,Dyspneic),Hemodynamic stability; (Blood pressure(MAP)<15%, Blood pressure 15-30%, Blood pressure>30%, Level of consciousness,(Awake&orientated Arousable with minimal stimulation, Responsive only to tactile stimulation),Oxygen saturation status(Maintains value>90% on room air, Requires supplemental oxygen, Saturation<90% with supplemental oxygen), Postoperative pain assessment(None or mild discomfort, Moderate to severe pain controlled with analgesics, Persistent severe pain), Postoperative emetic symptoms(None or mild nausea w/no active vomiting, Transient vomiting or retching, Persistent moderate to severe nausea&vomiting), Scoring is done as 2,1,0, respectively. A minimal score of 12(with no score<1 in any individual category)would be required for a patient after general anesthesia; Extremity movement (moves all four) Y/N, Stable vital signs( SBP > 90 and < 180, HR > 50 and < 110) Y/N, Dialogue (oriented person/place) Y/N, Oxygen saturation >90% in roExtremity movement (moves all four) Y/N, Stable vital signs( SBP > 90 and < 180, HR > 50 and < 110) Y/N, Dialogue (oriented person/place) Y/N, Oxygen saturation >90% in room air Y/N, Pain Control (VAS < 4) Y/N, Emesis Control Y/N. A patient must have a response of "yes" to all parameters to progress to phase II recovery
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        122 ASA (American Society of Anesthesiologists) physical status I-II patients, aged between
        18-65 years, undergoing elective lumbar discectomy under general anesthesia were included
        into the study.
      
Keywords: PACU-bypass; hospital discharge; lumbar discectomy