OBJECTIVEEnhanced Recovery After Surgery (ERAS) programs follow a multimodal, multidisciplinary perioperative care approach that combines evidence-based perioperative strategies to accelerate the functional recovery process and improve surgical outcomes. Despite increasing evidence that supports the use of ERAS programs in gastrointestinal and pelvic surgery, data regarding the development of ERAS programs in spine surgery are scarce. To evaluate the impact of an Enhanced Recovery After Spine Surgery (ERSS) program in a US academic cancer center, the authors introduced such a program and hypothesized that ERSS would have a significant influence on meaningful clinical measures of postoperative recovery, such as pain management, postoperative length of stay (LOS), and complications.METHODSA multimodal, multidisciplinary, continuously evolving team approach was used to develop an ERAS program for all patients undergoing spine surgery for metastatic tumors at The University of Texas MD Anderson Cancer Center from April 2015 through September 2016. This study describes the introduction of that ERSS program and compares 41 patients who participated in ERSS with a retrospective cohort of 56 patients who underwent surgery before implementation of the program. The primary objectives were to assess the effect of an ERSS program on immediate postoperative pain scores and in-hospital opioid consumption. The secondary objectives included assessing the effect of ERSS on postoperative in-hospital LOS, 30-day readmission rates, and 30-day postoperative complications.RESULTSThe ERSS group showed a trend toward better pain scores and decreased opioid consumption compared with the pre-ERSS group. There were no significant differences in LOS, 30-day readmission rate, or 30-day complication rate observed between the two groups.RESULTSAn ERSS program is feasible and potentially effective on perioperative pain control and opioid consumption, and can expedite recovery in oncological spine surgery patients. Larger-scale research on well-defined postoperative recovery outcomes is needed.

Objectives Measuring patient-reported outcomes (PROs) has become increasingly important for assessing quality of care and guiding patient management. However, PROs have yet to be integrated with traditional clinical outcomes (such as length of hospital stay) to evaluate perioperative care. This study aimed to utilize longitudinal PRO assessments to define the postoperative symptom-recovery trajectory in patients undergoing thoracic surgery for lung cancer. Methods Newly diagnosed patients (N=60) with stage I or II non-small cell lung cancer who underwent either standard open thoracotomy or video-assisted thoracoscopic surgery (VATS) lobectomy reported multiple symptoms from presurgery to 3 months postsurgery using the MD Anderson Symptom Inventory (MDASI). We conducted Kaplan–Meier analyses to determine when symptoms returned to presurgical levels and to mild severity levels during recovery. Results The most-severe postoperative symptoms were fatigue, pain, shortness of breath, disturbed sleep, and drowsiness. The median time to return to mild symptom severity for these 5 symptoms was shorter than return to baseline severity, with fatigue taking longer. Pain recovered more quickly for patients who underwent VATS lobectomy vs standard open thoracotomy (8 days vs 18 days, respectively; P = .022). Patients who had poor preoperative performance status or comorbidities reported higher postoperative pain (all P < .05). Conclusions Assessing symptoms from the patient's perspective throughout the postoperative recovery period is an effective strategy for evaluating perioperative care. This study demonstrates that the MDASI is a sensitive tool for detecting symptomatic recovery with an expected relationship among surgery type, preoperative performance status, and comorbid conditions.

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Objectives The primary objective of this randomized trial was to compare thoracic epidural analgesia (TEA) to intravenous patient controlled analgesia (IV-PCA) for pain control over the first 48 hours after hepatopancreatobiliary (HPB) surgery. Secondary endpoints were patient-reported outcomes, total narcotic utilization and complications. Summary of Background Data Although adequate postoperative pain control is critical to patient and surgeon success, the optimal analgesia regimen in HPB surgery remains controversial. Methods Using a 2.5:1 randomization strategy, 140 patients were randomized to TEA (N=106) or IV-PCA (N=34). Patient-reported pain was measured on a Likert scale (0–10) at standard time intervals. Cumulative pain area under the curve (AUC) was determined using the trapezoidal method. Results Between the study groups key demographic, comorbidity, clinical and operative variables were equivalently distributed. The median AUC of the postoperative time 0 to 48 hour pain scores was lower in the TEA group (78.6 vs 105.2 pain-hours, p=0.032) with a 35% reduction in patients experiencing ≥7/10 pain (43% vs 66%, p=0.05). Patient-reported outcomes and total opiate use further supported the benefit of TEA on patient experience. Anesthesia related events requiring change in analgesic therapy were comparable (12.2% vs. 2.9%, respectively, p=0.187). Grade ≥3 surgical complications, median length of stay (6 days vs 6 days), readmission (1.9% vs 3.1%), and return to the OR (0.9 vs 3.1%) were similar (all p>0.05). There were no mortalities in either group. Conclusions In major HPB surgery, TEA provides a superior patient experience through improved pain control and less narcotic use, without increased length of stay or complications.