Impact of general and regional anesthesia on discharge processing in knee arthroscopy patients

Introduction: Neal et.al. and Kopacz et. al. have shown chloroprocaine provides more rapid block resolution than lidocaine, but that time to discharge in an outpatient setting was no different. (1,2). We investigated what factors in addition to the choice of anesthetic technique or local anesthetic impact the total discharge time for outpatient arthroscopy. We theorized that discharge times might reflect traditional nursing discharge practices rather than choice of local anesthetic, and also evaluated the contribution of the type of arthroscopy procedure and its intra-operative duration to the overall discharge. Methods: Data from 242 patients was evaluated retrospectively using computer generated billing records collected during the first 6 months of 1996. Missing data points were obtained by individual chart review.. A patient was excluded because of conversion to general anesthesia and another because the primary anesthetic could not be identified. Patients who received combined spinal/epidural anesthetics were considered to have received spinal anesthetics if the epidural catheters were not dosed during the procedure. Total operating room time, PACU and step down unit times were recorded as well as the recovery area of initial presentation Total discharge times were compared for each of the regional and general anesthetic techniques. Each groups were further subdivided by type of regional or general anesthetic. The effect of the procedure type and duration were evaluated using an analysis of variance.. Results: The total operating room and discharge processing times for patients receiving either epidural, spinal and general anesthetics were not significantly different. (See table 1) The type of procedure did not affect discharge time, nor did the choice of anesthetic agent used in the spinal or epidural technique. The only difference in discharge groups were the patients admitted to the 6th floor PACU who then required transfer to the Discharge Unit. In comparison to the patients admitted directly to the 5th floor Discharge PACU, the former group required 37 minutes longer for discharge. Anesthetic type OR duration___ Discharge time epidural 71.3 +- 28.9 (SD) T41 +- 44 spinal 72.8 + - 20 133.8+ -59 general 77.7 + - 20.3 142 + - 46.8 Discussion: In patients undergoing knee arthroscopies, the total time to discharge does not appear to be affected by the specific arthroscopic procedure performed, nor the type of local anesthetic. Among patients who received general anesthetic, the only group who appeared to have a prolonged recovery were those patient who received propofol and nitrous oxide anesthetics. The major delay in discharge was created by a perceived need of the nusring staff to hold patients in the first recovery area for a minimum observation period. Therefore, we conclude that the type of arthroscopic procedure, the selection of anesthetic and agent used does not appear to have as significant and impact on the discharge time as traditional nursing and discharge practices. References:.