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Pain, nausea, vomiting and ocular complications delay discharge following ambulatory microdiscectomy
Shaheen Shaikh1, Frances Chung, Charles Imarengiaye
1Department of Anesthesia, Division of Neurosurgery, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada.
Objective:
Nowadays, microsurgical discectomy is being performed as an outpatient procedure. A retrospective chart review was done to document factors that delayed discharge or led to unanticipated admission.
Methods:
After Institutional Review Board approval, the hospital medical records of 106 patients who underwent microsurgical discectomy on an ambulatory basis were reviewed. All patients were operated upon by a single surgeon at the Toronto Western Hospital. Perioperative data were collected on specifically designed data sheets. All anesthetic and surgical factors that affected discharge were noted.
Results:
Of the 106 patients reviewed, only six required unanticipated admission. Two patients were admitted due to nausea and vomiting, one due to severe pain, one due to urinary retention and two were surgical causes (dural tear). Eight patients had delayed discharge. Anesthesia causes were severe nausea, severe pain, low oxygen saturation, sore throat and dry eyes. Two patients had surgical causes. The incidence of postoperative nausea was 61% and postoperative vomiting was 9.4%. Eighty patients (75.4%) complained of pain in the postanesthesia care unit. Of these, 33.9% had visual analogue pain scale scores more than 6.
Conclusion:
Ambulatory lumbar microdiscectomy can be carried out as an ambulatory procedure with an acceptably low unanticipated admission rate (5.7%). The percentage of patients with severe nausea (16%) and pain (33.9%) is high. Adequate perioperative pain management and effective control of nausea and vomiting may further improve the patients' experience after anesthesia for ambulatory microdiscectomy.
Insights
Ambulatory lumbar microdiscectomy is a safe outpatient procedure with a low admission rate. However, high incidences of postoperative nausea and pain suggest a need for improved management strategies to enhance patient experience.
Area of Science:
- Neurosurgery
- Anesthesiology
- Health Services Research
Background:
- Microsurgical discectomy is increasingly performed as an outpatient procedure.
- Factors influencing discharge and readmission require documentation for optimizing ambulatory care.
Purpose of the Study:
- To retrospectively review ambulatory lumbar microdiscectomy cases.
- To identify factors causing delayed discharge or unanticipated admission.
Main Methods:
- Retrospective chart review of 106 patients undergoing ambulatory lumbar microdiscectomy.
- Data collected on anesthetic and surgical factors affecting discharge.
- Single surgeon at Toronto Western Hospital.
Main Results:
- Low unanticipated admission rate of 5.7% (6/106 patients).
- Common causes for admission included nausea/vomiting, pain, urinary retention, and dural tear.
- High rates of postoperative nausea (61%) and pain (75.4%) in the postanesthesia care unit.
Conclusions:
- Ambulatory lumbar microdiscectomy is feasible with a low admission rate.
- Significant percentages of patients experience severe nausea and pain post-procedure.
- Improved perioperative pain and nausea/vomiting management can enhance patient outcomes.