Resident Carle BroMenn Medical Center Normal, Illinois, United States
Disclosure(s):
Megan Finneran, DO: No financial relationships to disclose
Introduction: Chiari malformation type I (CM-I) is a craniocervical junction disorder associated with >5 mm descent of the cerebellar tonsils through the foramen magnum. The majority of pediatric patients following Chiari decompression surgery are admitted to the pediatric intensive care unit (PICU). We sought to identify the safety and efficacy of postoperative floor management for medically non-complex postoperative Chiari decompression patients.
Methods: After a retrospective baseline assessment of 150 patients, a Quality Improvement (QI) initiative was implemented admitting medically non-complex patients to the floor postoperatively following Chiari decompression. Twenty-one medically non-complex patients were treated during the QI intervention period. All patients were assessed for length of stay, narcotic use, time to ambulation, and postoperative complications.
Results: PICU admission rates postoperatively decreased from 92.6% to 9.5%. Average length of stay decreased from 3.4 to 2.6 days, total doses of narcotic administration decreased from 12.3 to 8.7, and time to ambulation decreased from 1.8 to 0.9 days. There were no major postoperative complications identified that were unsuitable for management on a conventional pediatric medical/surgical nursing unit.
Conclusion : Medically non-complex patients were safely admitted to the floor postoperatively at Children’s Hospital Colorado after Chiari decompression. This approach afforded decreased length of stay, decreased narcotic use, and decreased time to ambulation with no major postoperative complications.
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