Fast track anesthesia for lumbar discectomy in outpatient basis: A retrospective observational study

Abstract

Aims: The use of short acting anesthetics has introduced a fast track anesthesia concept that allows the transfer of the patients from the operating room directly to the ward without a need for an observation in the post anesthesia care unit. The aim of this study was to evaluate whether fast tracking had an effect on the duration of hospital discharge after lumbar discectomy (LD) under general anesthesia (GA) between October 2017 and April 2018. Methods: Medical records of 252 American Society of Anesthesiologists physical status 1-2 patients were enrolled in this retrospective and observational study. The primary aim was to determine the patients who were eligible for fast tracking and to compare the duration of hospital discharge between fast track eligible and ineligible patients. The secondary aim was to identify the factors that prevented fast tracking and early hospital discharge. The value of p<0.05 was considered statistically significant. Results: More patients were eligible for fast tracking than those who were not eligible [176 (69.8%) vs. 76 (30.2%), p=0.012]. The duration of hospital discharge was lower in fast track eligible patients compared to ineligible patients (14.5±7.5 hours vs 17.8±7.3 hours; p=0.009). Pain was the most common cause of fast track ineligibility and delay in hospital discharge (42.1% and 64.5%; p<0.05). Conclusions: GA using short acting anesthetics could increase fast track eligibility which reduced the duration of hospital discharge after outpatient LD. Postoperative pain should be considered as a limiting factor for fast tracking and early hospital discharge