Autologous bone marrow harvesting in outpatients.
OBJECTIVE
To assess the experience with autologous bone marrow harvesting in outpatients.


METHODS
Retrospective analysis of outpatients who underwent autologous bone marrow harvesting from 1990 to 1992.


METHODS
University-affiliated surgical day hospital.


METHODS
235 outpatients who underwent 264 autologous bone marrow harvests. Patients are candidates for autologous bone marrow harvesting on an outpatient basis if they are Karnofsky performance status of 80-100 and ASA status I, II or III.


RESULTS
The incidence of perioperative complications and hospital admission from the Surgical Day Hospital, the duration of the harvesting procedure and postanesthesia care unit (PACU) stay, details of the postoperative pain management, and costs and charges of the outpatient procedure compared with the same procedure performed on inpatients were assessed. Mean age was 37.7 years +/- 10.5 SD; + 7.7% patients were male and 52.3% were female. The disease process included non-Hodgkin's lymph/ma (30.3%), leukemia (24.3%), metastatic breast cancer (18.4%), Hodgkin's disease (17.3%), testicular carcinoma (6.5%) and other (1.6%). The patients were ASA status II (54.5%) or ASA III (45.5%) and received general endotracheal anesthesia. Each patient had 10.7 ml/kg +/- 2.8 SD of marrow harvested over a period of 110.7 minutes + 30.4 SD and total recovery room time of 233.7 minutes +/- 85.5 SD. Of 251 harvest, only three (1.1%) required hospital admission. PACU complaints included transient hypotension and dizziness (5.3%), nausea (3.8%), vomiting (3.4%), and (1.9%) temperature elevation. 83.7% of patients were reached at home the following day and 4.1% complained of nausea and/or vomiting at home. 6.8% of patients experienced temperature elevation at home. Only 27.1% of patients took the acetaminophen with codeine that was prescribed. The reminder required no opioid at home. Outpatient charge/ inpatient charge was 51.1%, and outpatient cost/inpatient was 74.4%.


CONCLUSIONS
Autologous bone marrow harvesting is an acceptable ambulatory surgical procedure that results in a very law postanesthesia complication rate. Postoperative pain is easily controlled. The outpatient setting offers cost and time advantages to the patient.
Department of Anesthesiology, Cornel University Medical College, New York, NY, USA.
A C
AC
Thorne
K F
KF
Malbin
M
M
Jain
M
M
Stewart
S C
SC
Gulati
D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects / Q000191:economics; D000700:Analgesics / Q000627:therapeutic use; D000762:Anesthesia Recovery Period; D001853:Bone Marrow / Q000601:surgery*; D016026:Bone Marrow Transplantation; D001943:Breast Neoplasms / Q000556:secondary / Q000628:therapy; D002277:Carcinoma / Q000628:therapy; D005260:Female; D005334:Fever / Q000209:etiology; D006689:Hodgkin Disease / Q000628:therapy; D017722:Hospital Charges; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D015994:Incidence; D007442:Intubation, Intratracheal; D017567:Karnofsky Performance Status; D007902:Length of Stay; D007938:Leukemia / Q000628:therapy; D008228:Lymphoma, Non-Hodgkin / Q000628:therapy; D008297:Male; D009325:Nausea / Q000209:etiology; D010149:Postoperative Pain / Q000188:drug therapy; D010343:Patient Admission; D011183:Postoperative Complications; D012189:Retrospective Studies; D013736:Testicular Neoplasms / Q000628:therapy; D009927:Tissue and Organ Procurement / Q000191:economics; D014182:Transplantation, Autologous; D014839:Vomiting / Q000209:etiology
D000700:Analgesics