Intraoperative and Postoperative Anesthesia Management of Postoperative Visual Loss in Robotic Surgeries

Abstract

Problem Statement & Purpose: Postoperative vision loss (POVL) associated with robotic surgeries occurs at a rate of 1.9 events per 10,000 cases (Alwon & Hewer, 2016). Patients who have suffered from this event experience an increased hospital stay of 8.6 days as oppose to the standard 4.1 days. In addition, those that suffer ocular complications experience increased cost expenditures of $49,532 from $22,697 (Alwon & Hewer, 2016). Currently there is no standard of care in place at this level II trauma center in Baltimore, MD. Although the occurrence of this event is rare, this clinical practice guideline (CPG) was developed to effectively care for patients undergoing robotic surgery to prevent POVL. Methods: Development of the CPG was a collaborative effort amongst an expert panel that consisted of a chief anesthesiologist, a chief certified registered nurse anesthetist, a clinical site representative, and 2 Doctors of Nursing practice (DNP) students. A thorough evidence review was conducted, and an initial CPG was drafted. The draft CPG was presented to the expert panel where the AGREE II tool was used to evaluate the quality of the CPG. Modifications were made based on AGREE II tool feedback. The final CPG was presented to anesthesia providers during grand rounds where practitioner feedback questionnaires (PFQ) were disseminated. PFQ results were reviewed and analyzed. The final CPG was assembled and disseminated to the facility. Results: Each domain of the AGREE II tool received scores of higher than 85% with an overall average of 92% after modifications were made. Of the 25 PFQs received, 100% response rate was obtained from the three questions analyzed. Questions 8, 16, and 23 were analyzed and each received scores of 68%, 80%, and 76% respectively, strongly agreeing to adapt the CPG into practice. Conclusion: The CPG is a culmination of evidence-based practice recommendations to be utilized throughout the perioperative period for patients undergoing robotic surgeries. Based on the results obtained from the AGREE II tool and PFQ, the CPG was accepted by the anesthesia department. Use of this CPG provides education on POVL as well facilitates positive patient outcomes for this patient population.