Transcript Ebert | Handout - Mount Carmel College of Nursing

Benefits of the Use of a Cooling Blanket Postoperatively
in Lumbar Spine Fusion Patients
Dr. Daryl Sybert, DO, FAOAO and Kathleen Ebert RN, BSN
FINDINGS/RESULTS
INTRODUCTION
• A two sample t-test (p=0.05) was applied to the data to determine significance
• Statistical analysis shows a reduction in the time of immobility (p=0.03) and increased distance walked (p=0.001) in the experimental group
• The raw sample data did reveal a decrease in the time until oxygen was discontinued, increased bowel function, and decreased length of stay for
the experimental group
• The data did not reveal a statistically significant reduction in narcotic usage for the experimental group
• Annotated data revealed an increase in patient satisfaction in the experimental group
100%
Control
90%
A randomized inter-professional comparison study was conducted at Mount
Carmel New Albany Surgical Hospital. The study was submitted to the IRB and
approved. It was conducted from January 1, 2012 to December 31, 2012. There
were a total of 502 participants (n= 502).
All patients scheduled for elective lumbar spinal fusion surgery were given the
opportunity to participate in the study, and informed consent was obtained. Inclusion
criteria consisted of the following: 1) age 18-80, 2) delirium screen <5, 3) primary
phone number for follow up, and 4) English-speaking. Participants were excluded if
any of the following conditions were met: 1) an Acetaminophen drip was ordered or
initiated, 2) oxygen-dependency at home, or 3) physically unable to walk due to
disability not related to pain.
Participants were randomly assigned to a control (n= 245) or experimental group
(n=257). The control group received standard postoperative care with no cold
therapy. The experimental group received standard postoperative care with cold
therapy using a commercially-manufactured cooling blanket. The variables measured
were as follows: 1) length of stay, 2) use of narcotics for breakthrough pain, 3) use of
oxygen, 4) distance walked, 5) time of immobility, and 6) bowel function at 72 hours
postoperative.
The data were collected by an inter-professional staff team including nursing, case
management, pharmacy, respiratory therapy and physical therapy. The collected
data were then entered into a central database and subjected to statistical analysis to
determine significant differences in treatment variables.
80%
70%
60%
Distance (feet)
METHODOLOGY
Experimental
50%
40%
30%
20%
10%
0%
Bowels functioning normally at
72 hours
100
95
90
85
80
75
70
65
60
55
50
45
40
35
30
25
20
15
10
5
0
70
Control
65
Control
Experimental
60
Experimental
55
50
Elapsed Time (hours)
The purpose of the study was to determine if any benefits can be derived from the
use of a commercial cooling blanket immediately following lumbar spinal fusion
surgery. Although the use of ice packs for local cooling after knee surgery has been
studied in the past with mixed results there is limited research concerning their use in
lumbar spinal surgery. Local cooling has also been used in exercise studies and has
been shown to decrease inflammatory mediators which may cause pain and
decrease physical performance. Drawing from the previous research a study was
constructed to investigate the impact of cold therapy in spinal surgery.
45
40
35
30
25
20
15
10
5
0
Distance of first ambulation
Time from PACU admission Time from PACU admission Time from PACU admission
to first ambulation
to supp. O2
to discharge from MCNA
discontinuation
DISCUSSION & RECOMMENDATIONS
Initial findings reveal a reduction in the length of stay, decreased pain on admission, decreased length of time that oxygen was administered, and
increased bowel functions from the experimental group data. There was only found to be statistical significance for the distance ambulated and time to
ambulation.
The results of this research have led to a change in the standard order sets for all patients undergoing lumbar spinal fusion to include the use of a
commercial cooling blanket. Increased patient comfort, improved patient satisfaction, enhanced patient experience, and increased patient safety all
contribute to improved patient outcomes.
It is recommended that the study be repeated to further investigate the impact on use of oxygen, bowel function and length of stay.
Mount Carmel IRB File # 111207-1 Expedited Approval