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

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>The 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).</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>All 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.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Total 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.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>The implementation of a multimodal EPOC pathway decreased LOS and cost in major elective spine surgeries.</jats:p></jats:sec>

Consensus statement for perioperative care in lumbar spinal fusion: Enhanced Recovery After Surgery (ERAS®) Society recommendations

“…Current ERAS protocols for spinal surgery all emphasize the importance of preoperative patient education and counseling [30,38,39]. This appears appropriate given that preoperative information can influence patient expectations, and patients who receive sufficient counseling are likely to have higher levels of satisfaction than those who receive insufficient education [40].…”

Enhanced Recovery After Surgery Protocol in Minimally Invasive Lumbar Fusion Surgery Reduces Length of Hospital Stay and Inpatient Narcotic Use

“…For one, ERAS has been shown to be more cost effective than traditional care approaches. 3 , 13 , 19 , 20 It has also been found to significantly reduce LOS 3 , 8 , 9 , 10 , 13 , 14 , 19 , 21 , 22 , 23 , 24 , 25 , 26 length of intensive care unit stay, 3 , 19 postoperative pain scores, 9 , 20 , 21 amount of opioids used postoperatively in the hospital, 9 , 12 , 21 , 22 , 23 , 27 , 28 and postoperative catheterization. 22 , 26 , 27 Evidence also suggests that ERAS in spine surgery may reduce the amount of rescue antiemetic medications used, 29 readmission rate, 25 , 30 and reoperation rate.…”

“… 2 Since then, the movement has been adopted in multiple surgical specialties including gynecology, hepatobiliary, urology, colorectal, head and neck, breast, and bariatric surgery. 3 As the earliest discipline to adopt ERAS, colorectal surgery offers substantial literature supporting its benefit, 4 including evidence that ERAS results in significant reductions in morbidity, length of stay (LOS) and cost, and improvements to patient satisfaction. 5 , 6…”

Anesthetic considerations in spine surgery: What orthopaedic surgeon should know!

“…Further studies are required for addressing several elements of the protocol, such as general anesthesia versus conscious sedation anesthesia with sole use of TIVA, and a minimally invasive versus an open approach to spine surgery is the need of the hour. 52…”