Enhanced Recovery Components for Posterior Lumbar Spine Fusion

Echt, Murray; Poeran, Jashvant; Zubizarreta, Nicole; Girdler, Steven J; Mazumdar, Madhu; Galatz, Leesa M.; Memtsoudis, Stavros G.; Hecht, Andrew C.; Chaudhary, Saad B.

doi:10.1097/bsd.0000000000001242

Cited by 3 publications

(2 citation statements)

References 38 publications

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“…36 Several enhanced recovery after surgery protocols (ERAS) all emphasize the role of perioperative multimodal analgesia. 37,38 For a patient undergoing cervical spine surgery, this may include day of surgery acetaminophen and gabapentin, intraoperative lidocaine or ketorolac, and postoperative acetaminophen, NSAIDs, tramadol, and/or oxycodone depending on the degree of uncontrolled pain. 37 Although tramadol does confer some morphine equivalence, it has a much lower abuse potential than other narcotics 39 yet provides similar pain relief as fentanyl after cervical spine surgery.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Postoperative Opioid Use After Anterior Cervical Diskectomy and Fusion or Posterior Cervical Fusion

Lee

Issa

Lambrechts

et al. 2023

J Am Acad Orthop Surg

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Introduction: Posterior cervical fusion (PCF) and anterior cervical diskectomy and fusion (ACDF) are two main surgical management options for the treatment of cervical spondylotic myelopathy. Although ACDF is less invasive than PCF which should theoretically reduce postoperative pain, it is still unknown whether this leads to reduced opioid use. Our objective was to evaluate whether PCF increases postoperative opioid use compared with ACDF. Methods: We retrospectively identified all patients undergoing 2-level to 4-level ACDF or PCF at a single center from 2017 to 2021. Our state's prescription drug-monitoring program was queried for filled opioid prescriptions using milligrams morphine equivalents (MMEs) up to 1 year postoperatively. In-hospital opioid use was collected from the electronic medical record. Bivariate statistics compared ACDF and PCF cohorts. Multivariate linear regression was done to assess independent predictors of in-hospital opioid use and short-term (0 to 30 days), subacute (30 to 90 days), and long-term (3 to 12 months) opioid prescriptions. Results: We included 211 ACDF patients and 91 PCF patients. Patients undergoing PCF used more opioids during admission (126.7 vs. 51.0 MME, P < 0.001) and refilled more MMEs in the short-term (118.2 vs. 86.1, P = 0.001) but not subacute (33.6 vs. 19.7, P = 0.174) or long-term (85.6 vs. 47.8, P = 0.310) period. A similar percent of patients in both groups refilled at least one prescription after 90 days (39.6% vs. 33.2%, P = 0.287). PCF (β = 56.7, P = 0.001) and 30-day preoperative MMEs (β = 0.28, P = 0.041) were associated with greater in-hospital opioid requirements. PCF (β = 26.7, P = 0.039), C5 nerve root irritation (β = 51.4, P = 0.019), and a history of depression (β = 40.9, P < 0.001) were independently associated with 30-day postoperative MMEs. Conclusions: PCF is initially more painful than ACDF but does not lead to persistent opioid use. Surgeons should optimize multimodal analgesia protocols to reduce long-term narcotic usage rather than change the surgical approach. Level of Evidence:III

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Section: Discussionmentioning

confidence: 99%

Comparison of Postoperative Opioid Use After Anterior Cervical Diskectomy and Fusion or Posterior Cervical Fusion

Lee

Issa

Lambrechts

et al. 2023

J Am Acad Orthop Surg

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“…There are many protocols described in the literature and these can vary to great extent in their components. 27,28 Despite these variations, the goal of ERAS remains to improve patient outcomes by preoperative optimization, preemptive analgesia, opioid sparing multimodal anesthesia, early mobilization and nutrition etc. in an attempt to prevent catabolism and immune dysfunction.…”

Section: Components Of the Protocolmentioning

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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The Implementation of Enhanced Recovery After Spine Surgery in High and Low/Middle-income Countries: A Systematic Review and Meta-Analysis

Lele,

Moreton,

Mejia-Mantilla

et al. 2024

Journal of Neurosurgical Anesthesiology

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In this review article, we explore the implementation and outcomes of enhanced recovery after spine surgery (spine ERAS) across different World Bank country-income levels. A systematic literature search was conducted through PubMed, Embase, Scopus, and CINAHL databases for articles on the implementation of spine ERAS in both adult and pediatric populations. Study characteristics, ERAS elements, and outcomes were analyzed and meta-analyses were performed for length of stay (LOS) and cost outcomes. The number of spine ERAS studies from low-middle-income countries (LMICs) increased since 2017, when the first spine ERAS implementation study was published. LMICs were more likely than high-income countries (HICs) to conduct studies on patients aged ≥18 years (odds ratio [OR], 6.00; 95% CI, 1.58-42.80), with sample sizes 51 to 100 (OR, 4.50; 95% CI, 1.21-22.90), and randomized controlled trials (OR, 7.25; 95% CI, 1.77-53.50). Preoperative optimization was more frequently implemented in LMICs than in HICs (OR, 2.14; 95% CI, 1.06-4.41), and operation time was more often studied in LMICs (OR 3.78; 95% CI, 1.77-8.35). Implementation of spine ERAS resulted in reductions in LOS in both LMIC (−2.06; 95% CI, −2.47 to −1.64 d) and HIC (−0.99; 95% CI, −1.28 to −0.70 d) hospitals. However, spine ERAS implementation did result in a significant reduction in costs. This review highlights the global landscape of ERAS implementation in spine surgery, demonstrating its effectiveness in reducing LOS across diverse settings. Further research with standardized reporting of ERAS elements and outcomes is warranted to explore the impact of spine ERAS on cost-effectiveness and other patient-centered outcomes.

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Enhanced Recovery Components for Posterior Lumbar Spine Fusion

Cited by 3 publications

References 38 publications

Comparison of Postoperative Opioid Use After Anterior Cervical Diskectomy and Fusion or Posterior Cervical Fusion

Comparison of Postoperative Opioid Use After Anterior Cervical Diskectomy and Fusion or Posterior Cervical Fusion

Enhanced recovery after surgery (ERAS) protocol in spine surgery

The Implementation of Enhanced Recovery After Spine Surgery in High and Low/Middle-income Countries: A Systematic Review and Meta-Analysis

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