Enhanced recovery after surgery (ERAS) improves return of physiological function in frail patients undergoing one- to two-level TLIFs: an observational retrospective cohort study

Porche, Ken; Yan, Sandra C.; Mohamed, Basma; Garvan, Cynthia Wilson; Samra, Ronny; Melnick, Kaitlyn; Vaziri, Sasha; Seubert, Christoph N.; Decker, Matthew; Polifka, Adam; Hoh, Daniel J.

doi:10.1016/j.spinee.2022.04.007

Cited by 23 publications

(14 citation statements)

References 49 publications

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“…39 Additionally, in a retrospective cohort study of 32 geriatric patients at increased frailty risk undergoing 1-2 level transforaminal lumbar interbody fusion from 2015 to 2021, Porche et al observed that implementation of ERAS protocols signi cantly decreased LOS and time to return of function. 40 Other studies have assessed the relationship between frailty risk and outcomes using ERAS protocols for non-spinal procedures. In a retrospective American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) cohort study of 711 patients who underwent abdominal surgeries from 2014 to 2017, Hampton et al found that patients with increased mFI-5-de ned frailty risk enrolled in ERAS protocols had signi cantly shorter LOS.…”

Section: Discussionmentioning

confidence: 99%

Association of Frailty Risk with Hospital Outcomes after Surgical Resection for Benign and Malignant Spinal Meningiomas

Elsamadicy

Koo

Reeves

et al. 2022

Preprint

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OBJECTIVE The Hospital Frailty Risk Score (HFRS) is a metric used to assess patient frailty risk in large national datasets using International Classification of Diseases, Tenth Revision (ICD-10) codes. While previous studies have assessed the association between frailty risk and postoperative outcomes in spine oncology, there is a paucity of data on the relationship between frailty risk and outcomes in patients undergoing surgery for spinal meningiomas. The goal of this study was to investigate the association between HFRS and hospital length of stay (LOS), discharge disposition, and cost of admission in patients undergoing surgery for spinal meningiomas. METHODS A retrospective cohort study was performed using the National Inpatient Sample Database from 2016 to 2019. Adult patients with benign or malignant spine meningiomas, identified using ICD-10 diagnostic and procedural coding, were stratified by HFRS: Low (HFRS < 5) and Intermediate-High (HFRS ≥ 5). These cohorts were further stratified by patient sex. Patient demographics, treating hospital characteristics, comorbidities, intraoperative variables, perioperative adverse events (AEs), LOS, discharge disposition, and cost of admission were assessed. Logistic multivariate regression analyses were performed to identify the associations between increased HFRS and LOS, discharge disposition, and cost in male and female patients. RESULTS Of the 3,345 study patients, 530 (15.8%) had Intermediate-High Frailty. Of the 530 Intermediate-High risk patients, 410 (77.4%) were female and of the 2,815 Low risk patients, 2,185 (77.6%) were female. The Intermediate-High cohort was significantly older (Low: 60.94±14.63 years vs Intermediate-High: 66.93±14.23 years, p < 0.001). A greater proportion of patients in the Intermediate-High cohort had three or more comorbidities (Low: 32.5% vs Intermediate-High: 74.5%, p < 0.001). Additionally, a greater proportion of patients in the Intermediate-High cohort experienced one or more perioperative AEs (Low: 7.1% vs Intermediate-High: 14.2, p = 0.018). Intermediate-High patients had longer mean LOS (Low: 4.02±2.30 days vs Intermediate-High: 7.14±6.03 days, p < 0.001) and higher mean total costs (Low: $24,344±$16,743 vs Intermediate-High: $37,013±$27,547, p < 0.001). Furthermore, a greater proportion of Intermediate-High patients had non-routine discharges (Low: 27.9% vs Intermediate-High: 55.7%, p < 0.001). On multivariate analysis, increased HFRS scores (≥ 5) were significantly associated with extended LOS (p < 0.001), non-routine discharge (p = 0.006), and increased costs (p = 0.004). CONCLUSION Our study shows that increased HFRS-defined frailty risk is significantly associated with extended LOS, non-routine discharge disposition, and increased costs in patients undergoing surgery for spine meningiomas. Further studies on the implications of frailty in these patients are merited in order to improve patient outcomes and healthcare resource utilization.

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Section: Discussionmentioning

confidence: 99%

Association of Frailty Risk with Hospital Outcomes after Surgical Resection for Benign and Malignant Spinal Meningiomas

Elsamadicy

Koo

Reeves

et al. 2022

Preprint

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“…With regard to suboptimal outcomes with pre-frail and frail patients, some measures should be taken. In a recently published study, Porche et al 26 reported significantly improved recovery of physiological function and LOS after the implementation of enhanced recovery after surgery. Early ambulation as the backbone of enhanced recovery after surgery may decrease the risk of adverse events for pre-frail/frail patients.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Frailty on Perioperative Outcomes in Patients Receiving Short-Level Posterior Lumbar Interbody Fusion: A Stepwise Propensity Score Matching Analysis

Cui¹,

Wang²,

Wang³

et al. 2022

CIA

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Background: There are many studies on the impact of frailty on postoperative complications; however, there are few studies focusing on stepwise propensity score matching (PSM) to offset the influence of age. Methods: We gathered data for patients undergoing short-level posterior lumbar interbody fusion from January to December 2021. According to the Fried frailty phenotype, we categorized patients into non-frail, pre-frail, and frail groups, then, stepwise PSM for age, sex, American Society of Anesthesiologists (ASA) and fusion levels were performed to keep comparable clinical data between groups. Univariate and multivariate logistic regressions were used to determine the impact of clinical demographics on postoperative complications. Results: A total of 559 consecutive patients with complete medical records were enrolled (237 males and 322 females; mean age 72.55 ± 5.86 years). After PSM, we found that pre-frail patients were more vulnerable to develop urinary retention (p = 0.031) and surgical site infections (p = 0.021) than non-frail patients. Longer length of stay (LOS), delayed ambulation and removal of urinary catheter times were observed in pre-frail patients. However, there was a significant difference only in LOS between pre-frail and frail patients. Binary logistic regression revealed that C-reactive protein (CRP) and frail status were independently associated with postoperative complications between non-frail and pre-frail patients, while only CRP was independently correlated with complications between pre-frail and frail patients. Conclusion: After PSM, we found higher rates of urinary retention and surgical site infections in pre-frail patients than in non-frail patients. CRP was independently related to postoperative complications, while frail status was only independently associated with postoperative complications between pre-frail and non-frail patients. Pre-frail/frail patients tended to have more severe stress responses than non-frail patients.

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“…The results approximated outcomes of non-frail patients. 12 The applicability of ERAS has also been established for anterior cervical surgery. A retrospective case matched study in patients undergoing anterior cervical surgery on an ERAS pathway resulted in a significant decrease in LOS.…”

Section: Why Eras Protocols In Spine Surgery?mentioning

confidence: 99%

Enhanced recovery after surgery (ERAS) protocol in spine surgery

Bansal¹,

Sharan²,

Garg³

2022

Journal of Clinical Orthopaedics and Trauma

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Enhanced recovery after surgery (ERAS) improves return of physiological function in frail patients undergoing one- to two-level TLIFs: an observational retrospective cohort study

Cited by 23 publications

References 49 publications

Association of Frailty Risk with Hospital Outcomes after Surgical Resection for Benign and Malignant Spinal Meningiomas

Association of Frailty Risk with Hospital Outcomes after Surgical Resection for Benign and Malignant Spinal Meningiomas

The Impact of Frailty on Perioperative Outcomes in Patients Receiving Short-Level Posterior Lumbar Interbody Fusion: A Stepwise Propensity Score Matching Analysis

Enhanced recovery after surgery (ERAS) protocol in spine surgery

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