Identifying Components Necessary for an Enhanced Recovery After Surgery Pathway for Elective Intracranial Surgery: An Improvement Project Using the Quality of Recovery-15 Score.

Published

Journal Article

OBJECTIVE: To identify the domains of recovery, as determined by the Quality of Recovery-15 (QoR-15) score, that needed improvement to develop initial interventions for an enhanced recovery after surgery protocol for patients undergoing elective intracranial surgery under general anesthesia. METHODS: A paired-availability design was used to assess 2 groups of 41 patients undergoing elective intracranial surgery. The baseline QoR-15 score and scores 0, 6, 12, and 24 hours after arrival in the intensive care unit characterized the postoperative recovery trajectory. The lowest scoring domains of the QoR-15 score were identified in the preimplementation group, and pharmacologic interventions were initiated in the postimplementation group. RESULTS: Postoperative analgesia and postoperative nausea and vomiting were identified as the lowest scoring domains. The pharmacologic interventions implemented were chosen because they produced minimal sedation and were easy to administer-1 40-mg oral preoperative dose of aprepitant to target postoperative nausea and vomiting and 2 perioperative 1-g doses of intravenous acetaminophen to improve analgesia. We observed a clinically significant as well as statistically significant improvement in analgesia on arrival in the intensive care unit and at the 6-hour postoperative time point. The total QoR-15 score was improved through the 12-hour time point. CONCLUSIONS: In this quality improvement project, the QoR-15 score allowed us to identify domains that slowed the recovery course in this patient population. Two 1-g doses of intravenous acetaminophen improved patients' well-being and analgesia after elective intracranial surgery.

Full Text

Duke Authors

Cited Authors

  • Johnson, A; Rice, AN; Titch, JF; Gupta, DK

Published Date

  • October 2019

Published In

Volume / Issue

  • 130 /

Start / End Page

  • e423 - e430

PubMed ID

  • 31279110

Pubmed Central ID

  • 31279110

Electronic International Standard Serial Number (EISSN)

  • 1878-8769

Digital Object Identifier (DOI)

  • 10.1016/j.wneu.2019.06.108

Language

  • eng

Conference Location

  • United States