Accelerated Discharge Protocol for Posterior Spinal Fusion Patients With Adolescent Idiopathic Scoliosis Decreases Hospital Postoperative Charges 22%

Sanders, Austin; Andras, Lindsay M.; Sousa, Ted; Kissinger, Cathy; Cucchiaro, Giovanni; Skaggs, David L.

doi:10.1097/brs.0000000000001666

Cited by 88 publications

(55 citation statements)

References 13 publications

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“…The EPOC pathway in major spine surgery achieved similar results to 2 previously reported "accelerated discharge" pathways in adolescent idiopathic scoliosis, including decreased cost and decreased LOS. 7,18 These results are in contrast to those of a recent publication about ERAS for metastatic spine lesions, which found no benefit to LOS but did find a decrease in postoperative pain scores. 8 Our study has several limitations.…”

Section: Discussioncontrasting

confidence: 92%

Enhanced perioperative care and decreased cost and length of stay after elective major spinal surgery

Carr

Saigal

Zhang

et al. 2019

Neurosurgical Focus

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OBJECTIVEThe purpose of this study was to compare total cost and length of stay (LOS) between spine surgery patients enrolled in an enhanced perioperative care (EPOC) pathway and patients receiving traditional perioperative care (TRDC).METHODSAll spine surgery candidates were screened for inclusion in the EPOC pathway. This cohort was compared to a retrospective cohort of patients who received TRDC and a concurrent group of patients who met inclusion criteria but did not receive the EPOC (no pathway care [NOPC] group). Direct and indirect costs as well as hospital and intensive care LOSs were analyzed between the 3 groups.RESULTSTotal costs after pathway implementation decreased by $19,344 in EPOC patients compared to a historical cohort of patients who received TRDC and $5889 in a concurrent cohort of patients who did not receive EPOC (NOPC group). Hospital and intensive care LOS were significantly lower in EPOC patients compared to TRDC and NOPC patients.CONCLUSIONSThe implementation of a multimodal EPOC pathway decreased LOS and cost in major elective spine surgeries.

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Section: Discussioncontrasting

confidence: 92%

Enhanced perioperative care and decreased cost and length of stay after elective major spinal surgery

Carr

Saigal

Zhang

et al. 2019

Neurosurgical Focus

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“…Sanders et al 42 tested an AD pathway for the management of AIS in 90 patients compared to 194 patients managed with a TD pathway. Their pathway incorporated similar measures to those described by Fletcher et al Shorter mean durations of hospitalization were seen when comparing the two groups (3.7 vs 5.0 days, p < 0.001).…”

Section: Correction Of Scoliosis and Spinal Deformitymentioning

confidence: 99%

Enhanced recovery after spine surgery: a systematic review

Elsarrag¹,

Soldozy²,

Patel³

et al. 2019

Neurosurgical Focus

180

113

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OBJECTIVEEnhanced recovery after surgery (ERAS) is a multidimensional approach to improving the care of surgical patients using subspecialty- and procedure-specific evidence-based protocols. The literature provides evidence of the benefits of ERAS implementation, which include expedited functional recovery, decreased postoperative morbidity, reduced costs, and improved subjective patient experience. Although extensively examined in other surgical areas, ERAS principles have been applied to spine surgery only in recent years. The authors examine studies investigating the application of ERAS programs to patients undergoing spine surgery.METHODSThe authors conducted a systematic review of the PubMed and MEDLINE databases up to November 20, 2018.RESULTSTwenty full-text articles were included in the qualitative analysis. The majority of studies were retrospective reviews of nonrandomized data sets or qualitative investigations lacking formal control groups; there was 1 protocol for a future randomized controlled trial. Most studies demonstrated reduced lengths of stay and no increase in rates of readmissions or complications after introduction of an ERAS pathway.CONCLUSIONSThese introductory studies demonstrate the potential of ERAS protocols, when applied to spine procedures, to reduce lengths of stay, accelerate return of function, minimize postoperative pain, and save costs.

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“…27 Others have demonstrated the benefits of an accelerated protocol in AIS surgery, which included discontinuing both the PCA and the urinary catheter by the afternoon of the first postoperative day and having patients ambulate with physiotherapy. 28 The benefits included fewer patients having to return to the operating theatre and earlier discharge from hospital (average 3.7 days) with no difference in complication rates or wound complications. 28 In another study, early removal of the urinary catheter together with physiotherapy and the introduction of a solid diet on postoperative day (POD) 1 was associated with a 50% reduction in hospital stay.…”

Section: Postoperative Managementmentioning

confidence: 99%

“…28 The benefits included fewer patients having to return to the operating theatre and earlier discharge from hospital (average 3.7 days) with no difference in complication rates or wound complications. 28 In another study, early removal of the urinary catheter together with physiotherapy and the introduction of a solid diet on postoperative day (POD) 1 was associated with a 50% reduction in hospital stay. 29 It is difficult to say which aspects of the various protocols contributed most to reduced length of stay, or whether the interventions as a group had a synergistic effect.…”

Section: Postoperative Managementmentioning

confidence: 99%