Postoperative general medical ward admission following Chiari malformation decompression
OBJECTIVE
Prior to 2019, the majority of patients at Children’s Hospital Colorado were admitted to the pediatric intensive care unit (PICU) following Chiari malformation (CM) decompression surgery. This study sought to identify the safety and efficacy of postoperative general ward management for these patients.
METHODS
After a retrospective baseline assessment of 150 patients, a quality improvement (QI) initiative was implemented, admitting medically noncomplex patients to the general ward postoperatively following CM decompression. Twenty-one medically noncomplex patients were treated during the QI intervention period. All patients were assessed for length of stay, narcotic use, time to ambulation, and postoperative complications.
RESULTS
PICU admission rates postoperatively decreased from 92.6% to 9.5% after implementation of the QI initiative. The average hospital length of stay decreased from 3.4 to 2.6 days, total doses of narcotic administration decreased from 12.3 to 8.7, and time to ambulation decreased from 1.8 to 0.9 days. There were no major postoperative complications identified that were unsuitable for management on a conventional pediatric medical/surgical nursing unit.
CONCLUSIONS
Medically noncomplex patients were safely admitted to the general ward postoperatively at Children’s Hospital Colorado after decompression of CM. This approach afforded decreased length of stay, decreased narcotic use, and decreased time to ambulation, with no major postoperative complications.
ABBREVIATIONS
CHCO = Children’s Hospital Colorado; CI = confidence interval; CM = Chiari malformation; CM-I = CM type I; ERAS = enhanced recovery after surgery; ICU = intensive care unit; OSA = obstructive sleep apnea; PACU = postanesthesia care unit; PICU = pediatric ICU; POD = postoperative day; QI = quality improvement; rFLACC = revised Face, Legs, Activity, Cry, Consolability.Images from Chiang et al. (pp 595–601).
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