AUTOLOGOUS BONE-MARROW HARVESTING IN OUTPATIENTS

Study Objective: To assess the experience with autologous bone marrow harvesting in outpatients. Design: Retrospective analysis of outpatien ts who underwent autologous bone marrow harvesting from 1990 to 1992. Setting: University-affiliate surgical day hospital. Subjects: 235 out patients who underwent 264 autologous bone marrow harvests. Patients a re candidates, for autologous bone marrow harvesting on an outpatient basis if they are Karnofsky performance status of 80-100 and ASA statu s I, II or III. Measurements and Main Results: The incidence of periop erative complications and hospital admission from the Surgical Day Hos pital, the duration of the harvesting procedure and postanesthesia car e unit (PACU) stay, details of the postoperative pain management, and costs and changes of the outpatient procedure compared with the same p rocedure performed on inpatients were assessed. Mean age runs 37.7 yea rs +/- 10.5 SD; 47.7% patients were male and 52.3% were female. The di sease processes included non-Hodgkin's lymphoma (30.3%), leukemia (24. 3%;), metastatic breast cancer (18.4%), Hodgkin's disease (17.3%), tes ticular carcinoma (6.5%), and other (1.6%). The patients were ASA stat us II (54.5%) or ASA III (45.5%) and received general endotracheal ane sthesia. Each patient had 10.7 ml/kg +/- 2.8 SD of marrow harvested ov er a period of 110.7 minutes +/- 30.4 SD and total recovery room time of 233.7 minutes +/- 85.5 SD. Of 264 harvests, only three (1.1%) requi red hospital admission. PACU complaints included transient hypotension , and dizziness (5.3%), nausea (3.8%), vomiting (3.4%), and (1.9%) tem perature elevation. 83.7% of patients were reached at home the followi ng 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 pati ents took the acetaminophen with codeine that was prescribed. The rema inder required no opioid at horne. Outpatient charge/inpatient charge was 51.1%, and outpatient cost/inpatient was 74.4%. Conclusion: Autolo gous bone marrow harvesting is an acceptable ambulatory surgical proce dure that results in a very low postanesthesia complication rate. Post operative pain is easily controlled. The outpatient setting offers cos t and time advantages to the patient. (C) 1996 by Elsevier Science Inc .