Commentary

Don’t rush to use surgical fast-tracking

An outcomes data analyst comments

By Richard E. Gilder, RN, BSN, CNOR

Presbyterian Healthcare System

Dallas

Fast-tracking really is a function of anesthesia technique. The rapidly dispersed volatile anesthetic agents such as sevoflurane and desflurane have such low solubilities in blood so as to rival nitrous oxide. Agents such as propofol also have a rapid onset of action and an exceedingly short serum half-life. The net effect is that the patient goes out like a light and comes back equally fast.

Fast-tracking is also finding its way into cardiac bypass procedures, resulting in decreased length of stay by virtue of faster recovery time. It is not uncommon for patients to be discharged the next day.

I agree that there is no one simple answer. What works for one department or facility could be a disaster when tried in another, but one thing is clear: The use of rapid anesthesia agents and their new technology is expensive. Desflurane is almost worth its weight in gold. Propofol is very costly in a primary agent-to-agent comparison with either halothane or isoflurane. When propofol is used for maintenance, the recovery time is only a few minutes shorter than that of all the other inhalational anesthetics.

The question about the magnitude of the savings needs to be asked as well. How much savings? Who is the beneficiary of the savings? The added cost of yet another anesthesia monitor may be just enough to ensure that the whole process results in a greater cost, which would mean a lower profit, no matter what salary structure is in place at the facility.

On the other hand, if a new monitor has the potential to show the kind of all-around magnitude of benefit to the patient, the practitioner, and the facility that was demonstrated by pulse oximetry in reducing complications of anesthesia, then it would be worth it no matter what the direct or indirect cost would be. The question remains to be answered and needs to be aggressively investigated.

For more information, contact Richard E. Gilder, RN, BSN, CNOR, clinical information systems administrator, senior data analyst, department of clinical outcomes resource management, Presbyterian Healthcare System, Dallas. Telephone: (214) 345-4361. E-mail: gilderr@wpmail.phscare.org.