Quality of Recovery in Veterans Following Postoperative Ketamine Infusion Implementation

Chronic pain is highly prevalent among Veterans and contributes to poor surgical recovery. This pilot quality improvement project evaluated a structured postoperative ketamine infusion program at a Veterans Affairs medical center. Veterans with chronic pain undergoing complex surgery received low-dose ketamine infusions (0.2 mg/kg/hr) for 24-72 hours postoperatively. The Quality of Recovery-15 (QoR-15), a validated patient-reported measure, was collected on postoperative days 2, 7, and 30. A minimal clinically important difference (MCID) of six points was used to define meaningful improvement. Among 21 participants, 80% achieved clinically meaningful recovery, with mean scores rising from 84 (poor recovery) on day 2-124 (good recovery) by day 30. No ketamine-related adverse events were reported. The program was successfully implemented across multiple postoperative and inpatient settings with structured nursing education and standardized monitoring procedures. This project is novel in demonstrating the feasibility of a standardized ketamine infusion protocol delivered outside intensive care within a Veterans Affairs hospital. Findings suggest that ketamine infusions were associated with safe, sustained improvements in postoperative recovery among Veterans with chronic pain. Results underscore the importance of nursing-led implementation strategies and highlight ketamine's potential role as a scalable, multimodal pain management intervention for high-risk surgical populations.