Evaluation of Recovery Patterns in Post- Operative Patients Using Fast-Track Criteria and Modified Aldrete Scoring System after Surgical Anaesthesia in Patient Management

Abstract

Aim: The post-operative period is the most critical phase for the surgical patients, requiring close observation. A study was conducted to assess and evaluate patients post-operative recovery course following surgical anesthesia using post anesthesia recovery assessment scoring systems for optimal and timely patient management, so as to ensure a safe postoperative recovery course, thus decreasing morbidity as well as mortality.

Study Design: Observational Study

Place and Duration of Study: This study was carried out in the Department of Anesthesia and Intensive Care, Holy Family Hospital, Rawalpindi, from the period 30-01-2010 to 18-2-2010 and in the Department of Anesthesia and Intensive Care Unit, Islam Teaching Hospital, Islam Medical college, Sialkot, from 16-9-2010 to 28-2-2011.

Materials and Methods: In the study, patients undergoing elective surgical procedures in general as well as regional anesthesia were included. The patient’s age group was between 15-85 years and belonged to American Society of Anaesthesiologists (ASA) physical status class 1-3 as well as medically optimized ASA-class 4 patients. On discontinuation of general anesthesia patients were assessed for conscious state, cardiovascular stability (pulse and blood pressure) and motor recovery. The Fast-Track criteria were used to assess initial recovery of patient in the operating area. Patients were then shifted to Post Anesthesia Care unit, where recovery assessment was done by continuation of Fast-Track Criteria^1,2,3 and also by employing the Modified Aldrete scoring system⁴ immediately, and at five, fifteen, thirty minutes and then at one hr interval depending on clinical physiological status of the patient and the level of score achieved. The patients further management intervention was guided in the light of scores attained, which depicted the physiological alteration. The Post-Anesthesia Discharge scoring system^5,6 and Aldrete recovery score⁷ modified for day surgery was used to assess physiological status of patient before shifting them to the surgical ward or for assessment of home readiness.

Data was compared and analyzed by SPSS version 17. Mean ± S.D was calculated for quantitative variables, age etc. Frequencies and percentages were presented for qualitative variables e.g. gender and various scoring systems used in the study. Spearman’s  Rank  correlation  was  used  to  check  interdependence  between  the  two  variables  i.e. Fast-Track criteria^1,2,3 and Modified Aldrete scoring system⁴. The P-value of <0.05 was considered statistically significant.

Results: A total of one hundred and ninety nine patients were checked in the study (one hundred and six females and ninety three males) out of which one hundred and fifty seven i.e. 78.89% patients were shifted to respective wards uneventfully. A total of eleven patients i.e. 5.52% needed urgent advanced management care and were shifted to surgical intensive care, while three patients i.e. 1.50% were placed on ventilatory  support as guided by the recovery scoring system scores attained and pathological status of the patients. Thirty one patients i.e. 15.57% were discharged to home safely. Thirty patients i.e. 15.07% were ‘Fast Tracked’ in the study from the operation theatre bypassing the first stage of the traditional two stage recovery process. The value of correlation co-efficient (r) was significant at the 0.01 level.

Conclusion: The Fast-Track scoring criteria^1,2,3 along with Modified Aldrete scoring system⁴ offers guidance in evaluating post-operative recovery of patients from surgical anesthesia for optimal patient management, so as to decrease morbidity.