Pain Management Still a Constraint to Outpatient Procedures

Surgery is on the move: With enhanced recovery protocols, procedures that once required several days of in-hospital recovery are shifting to the outpatient setting without compromising patient care. However, there are still major barriers to consider | Anesthesiology News 


At the Interdisciplinary Conference on Orthopedic Value-Based Care, Tong Joo (T.J.) Gan, MD, FRCA, MHS, assessed the feasibility of outpatient arthroplasty and selected spine procedures. “Carefully selected patients in combination with enhanced recovery principles and pathways enable total knee replacement and spinal surgery to be done on an outpatient basis,” said Dr. Gan, who is professor and chairman of the Department of Anesthesiology, Stony Brook Medicine, in New York, “but pain management, postoperative nausea and vomiting (PONV) and rehabilitation are major constraints.”

In a narrative review by Henrik Kehlet, MD, the so-called “father of enhanced recovery after surgery” (ERAS), several potential barriers to outpatient total knee arthroplasty were delineated, including the patient’s social network and comorbidity profile, but pain was the major limiting factor (Bone Joint J 2015;97-B[10 Suppl A]:40-44). “Severity of pain was shown to be one of the main causes of increased length of stay,” Dr. Gan said. “Approximately 50% of patients reported moderate to major pain following surgery, and 30% had either severe or extreme pain.”

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