McDowell MM, Alhourani A, Pearce-Smith BA, Mazurkiewicz A, Friedlander RM. Cost-Effectiveness of Postoperative Ketamine in Chiari Decompression.
World Neurosurg 2017;
110:e599-e604. [PMID:
29175573 DOI:
10.1016/j.wneu.2017.11.061]
[Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/09/2017] [Accepted: 11/11/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION
In Chiari I patients, postoperative pain and discomfort frequently slow the transition back to the home setting.
OBJECTIVE
We sought to determine the effect of standardized ketamine infusion protocols on hospital length of stay (LOS).
METHODS
This retrospective cohort study reviewed 100 consecutive adult patients undergoing Chiari I decompression. Fifty-nine patients were placed on a 2-3 mg/hr ketamine drip until postoperative day 1. This group was compared with a group who received 2-3 mg/hr of ketamine until postoperative day 2 (19 patients) and patients who did not receive ketamine at all (22 patients). Clinical characteristics, opioid use, LOS, and relative hospitalization costs were assessed. All narcotic amounts were converted into milligram equivalents of morphine.
RESULTS
LOS of the short-ketamine group was 46.5 hours when compared with the long-ketamine group (66.8 hours) and no-ketamine group (56.9 hours). There was a statistically significant difference when comparing the short-ketamine group with the long-ketamine group and no-ketamine group together (P < 0.001), as well as when compared individually (P = 0.001 and 0.004). The mean cost of hospitalization was 20% less when a short-ketamine protocol was used (P < 0.001). Mean morphine milligram equivalents used postoperatively were 148 mg in the short-ketamine group, 196 mg in the long-ketamine group, and 187 mg in the no-ketamine group (P = 0.65). No adverse events from ketamine were noted.
CONCLUSIONS
Ketamine at subanesthetic levels may be an effective tool to facilitate early return home postoperatively and may significantly reduce medical costs.
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