F. Cheema1, S. Lee1, M. Zebrower2, J. L. Poggio1 1Drexel University College Of Medicine,Department Of Surgery,Philadelphia, PA, USA 2Drexel University College Of Medicine,Department Of Anesthesiology & Perioperative Medicine,Philadelphia, PA, USA
Introduction: Prone jackknife position allows for improved anatomical exposure during anorectal procedures. Debate exists regarding morbidity and anesthetic complications in this position. The primary objective of this study was to determine morbidity and mortality rates of ambulatory anorectal surgeries in prone jackknife position. The secondary objective was to determine which patient characteristics led to higher risk of morbidity and mortality.
Methods: Retrospective chart analysis was performed on 210 patients undergoing ambulatory anorectal surgery in the prone jackknife position in an academic hospital from 2012 to 2014. Factors analyzed were age, sex, clinical diagnosis, procedure, past medical history, ASA physical status classification, current smoking status, minimum intra-operative mean arterial pressure (MAP), minimum O2 saturation, estimated blood loss, fluids, anesthesia duration, antibiotic administration, days to discharge and 30-day readmissions. All patients underwent general anesthesia. Data was provided from history & physical forms, operative notes, anesthesia flowsheets and progress notes. Frequencies and means of the factors were calculated. Mortality was included only if it occurred within 30 days of surgery.
Results: Of 210 patients undergoing ambulatory anorectal surgery, there were no mortalities within 30 days of surgery. Mean age was 44.6 and 72.4% of patients were male. Complication rate was 3.3% with urinary retention taking up 42% of that. 30-day readmission rate from surgery was 1%. This encompassed two cases of rectal bleeding status-post excision & fulguration of anal condylomas and bright red blood per rectum status-post hemorrhoid surgery. 98.1% of patients were discharged same day of surgery. Mean minimum intra-operative MAP and O2 saturation was 70.6 and 98.7%, respectively. The most common clinical diagnoses were anal condylomas (37.6%), hemorrhoids (14.8%) and pilonidal cysts (11%). The most common procedures therefore were excision & fulguration, hemorrhoidal surgery and pilonidal cyst excision. Anal condyloma was the most common past medical history (40.4%), followed by HIV/AIDS (39%) and hypertension (32.3%). Current smoking rate was 45.7%. Mean ASA classification was 2.29, with mean blood loss of 6.22 cc, mean fluids given of 1015 cc, and mean anesthesia duration of 92 minutes. Antibiotics were not administered in 68.1% of cases.
Conclusion: Prone jackknife position in ambulatory anorectal surgeries under general anesthesia provides enhanced exposure and is a safe procedure with no mortality and minimal morbidity. Total complication rate was 3.3%, urinary retention being most common. Given the results, this study provides evidence that ambulatory anorectal surgery in prone jackknife position is relatively safe in terms of morbidity and mortality as well as anesthetic complications when considering the factors analyzed in this study.
