Ambulatory Surgery Protocol Reduces Post-Op Returns

A new study shows that implementation of a standardized protocol for ambulatory anorectal surgery decreased postoperative pain and unplanned return visits to emergency care.

Researchers at Kaiser Permanente Southern California (KPSC; Pasadena, USA) conducted a retrospective review of data from 14 KPSC medical centers in order to evaluate a modified enhanced recovery after surgery (ERAS) protocol for ambulatory anorectal surgery, which includes eight items: preoperative education, preoperative distribution of prescriptions, preoperative carbohydrate treatment, multimodal analgesia, preferential use of monitored anesthesia care (MAC), routine use of local anesthesia/regional blocks, intraoperative restriction of intravenous fluids, and post-discharge phone call.

Results showed that postoperative pain scores were reduced when all eight elements of the protocol were delivered. There was reduced postoperative pain when preoperative carbohydrate treatment was completed, with MAC, and when multimodal analgesia was used. There were decreased preventable returns to the emergency department or urgent care when MAC was used, and there were more returns for constipation, but fewer returns for pain, following preoperative carbohydrate treatment. Local anesthesia was associated with fewer returns for constipation. The study was published on January 9, 2018, in World Journal of Surgery.

“When people return to the emergency department or urgent care for pain control, urinary retention, constipation, or nausea and vomiting after same day inguinal hernia repair, we feel that those returns could have been prevented if our perioperative care routines had addressed them up front,” said study co-author Steven Crain, MD, of KPSC Woodland Hills. “With these standardized pathways, we’re able to improve the quality of care for the patient and the efficiency of health care delivery for the organization.”

MAC, also known as twilight sleep, is a planned procedure during which the patient undergoes local anesthesia together with sedation and analgesia in order to provide safe conscious sedation, control of patient anxiety, and pain control. MAC can be obtained with the association of fast half-life drugs or via an infusion regimen. Patient consciousness evaluation is also of extreme importance during the surgical procedure performed with MAC.

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Kaiser Permanente Southern California