Quality of Recovery in Veterans Following Postoperative Ketamine Infusion Implementation

Area of Science:

• Anesthesiology and Pain Management
• Quality Improvement in Healthcare
• Veterans Health Administration

Background:

• Chronic pain significantly impacts Veterans, complicating surgical recovery.
• Postoperative recovery is often poor in surgical patients with pre-existing chronic pain.
• Veterans Affairs (VA) medical centers face challenges in managing complex surgical cases with chronic pain.

Purpose of the Study:

• To evaluate a structured postoperative ketamine infusion program for Veterans with chronic pain undergoing complex surgery.
• To assess the feasibility and effectiveness of a novel ketamine infusion protocol outside the intensive care unit (ICU).
• To determine if ketamine infusions improve postoperative recovery quality in this high-risk population.

Main Methods:

• A pilot quality improvement project involving 21 Veterans with chronic pain undergoing complex surgery.
• Administration of low-dose ketamine infusions (0.2 mg/kg/hr) for 24-72 hours postoperatively.
• Utilized the Quality of Recovery-15 (QoR-15) scale to measure recovery on postoperative days 2, 7, and 30.

Main Results:

• 80% of participants achieved clinically meaningful recovery, defined by a QoR-15 score increase of ≥6 points.
• Mean QoR-15 scores improved significantly from 84 (poor recovery) on day 2 to 124 (good recovery) by day 30.
• No adverse events related to ketamine administration were reported; the program was successfully implemented with nursing education and monitoring.

Conclusions:

• A structured, nursing-led ketamine infusion program is feasible and safe for improving postoperative recovery in Veterans with chronic pain.
• Ketamine infusions demonstrate potential as a scalable, multimodal pain management strategy for high-risk surgical populations within the VA system.
• This study highlights the importance of innovative, non-opioid pain management approaches in enhancing surgical outcomes for Veterans.