SSAT - Adjunctive Ketamine Therapy May Help Reduce Length of Stay in Selected Patients Undergoing Foregut Surgery

Adjunctive Ketamine Therapy May Help Reduce Length of Stay in Selected Patients Undergoing Foregut Surgery
Shuja Yousuf^*², Yana Nikitina², Ike Eriator³, Kenneith Oswalt³, Timothy J. Beacham³, Anand Prem³, Wanda J. Keahey⁶, Archana Kedar², Mubina Isani⁵, Thomas S. Helling⁴, Christopher J. Lahr⁴, Thomas L. Abell¹
¹Digestive Diseases, University of Louisville Medical Center, Louisville, KY; ²Digestive Diseases, University of Mississippi Medical Center, Jackson, MS; ³Anesthesiology, University of Mississippi Medical Center, Jackson, MS; ⁴Surgery, University of Mississippi Medical Center, Jackson, MS; ⁵Surgery, University of North Carolina, Chapel Hill, NC; ⁶Medication Management Specialists Inc, Jackson, MS

Background: We have previously reported that the length of stay (LOS) for the postoperative elective gastric electric stimulation (GES) for gastroparesis (Gp) patients is reduced when admitted to a hospitalist service, campared to traditional standard of care (SOC) Surgery/GI service. One issue for prolonged LOS for postoperative Gp patients has been post-operative pain and ketamine hydrochloride has been shown, when used adjunctively, to assist in pain management. Since underlying chronic and pre-existant pain often often is aoosciated with prolonged LOS in patients undergoing surgical intervention for GES, we examined whether the use of low dose ketamine hydrochloride could further reduce LOS in gastroparesis (GP) patients undergoing GES placement.Methodology: Using a pre-established and ongoing database, we examined three groups of patients, all undergoing the identical operation for placement of gastric electrical stimulators: the first group - 16 patients on a combined Surgery/GI service with the use of adjunctive ketamine hydrochloride, via an anesthesia based care protocol (the ketamine group): the second group - 16 patients receiving hospitalist service care post-operatively (hospitalist group), and the third group -16 patients on a combined Surgery/Gastroenterology (GI) service receiving standards of care (SOC) without the use of ketamine hydrochloride (non-hosptalist group). Patients receiving ketamine hydrochloride were matched, by primary diagnosis and IDIOMS scores for health resource utilization (NGM 2005; 17: 35-43), with the other 2 groups. All data were analyzed by group, reported as mean and standard deviation values, and compared by student t-tests. Results: In the third group-- ketamine hydrochloride, the average length of stay (ALOS) was 6 days, in the second group—hospitalist, it was 6.5 days and in the first group--non-hospitalist, ALOS was 10 days. There was no statistical difference for the adjunctive ketamine hydrochloride group than the hospitalist service (p=0.753) and but the ketamine (and also as previously reported, the hospitalist) were significantly lower than the non-hospitalist Surgery/GI service (SOC) group (p= 0.010.) (See table). Conclusion: We conclude that adjunct low dose ketamine hydrochloride may reduce the length of stay in patients with gastroparesis, many of who have a chronic pain disorder, when undergoing foregut surgery.
Ketamine

Patient Service Mean of LOS ± SD P value
Non-hospitalist with ketamine hydrochloride 6.0±3.4 ------
Hospitalist service 6.5±5.3 0.75
Non-hospitalist service 10±4.7 0.01

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