Enhanced recovery pathway in adult patients undergoing thoracolumbar deformity surgery

Kim, Hee Jin; Steinhaus, Michael E.; Punyala, Ananth; Shah, Sachin; Elysée, Jonathan; Lafage, Renaud; Riviera, Tom; Méndez, Guillermo; Ojadi, Ajiri; Tuohy, Sharlynn; Qureshi, Sheeraz A.; Urban, Mi­chael; Craig, Chad M.; Lafage, Virginie; Lovecchio, Francis

doi:10.1016/j.spinee.2021.01.003

Cited by 22 publications

(14 citation statements)

References 36 publications

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“…Previously, because of the reduction of bladder function and the longer functional recovery of spine surgery, few studies explicitly illustrated the time of ambulation and removal of a bladder catheter and only stressed the concept of early ambulation and early removal of the bladder catheter. 29 , 30 Given the adverse events associated with prolonged bed rest and the importance of early ambulation in reducing LOS, 29 , 31 attention should also be paid to adverse events related to prolonged urinary drainage (urinary tract infections and surgical site infections). 32 , 33 In a before and after cohort study on elderly patients who underwent elective spine and peripheral nerve surgery, Ifrach et al 34 showed improved mobilization and ambulation on POD 0 in ERAS group, and proved the safety and feasibility of early mobilization and ambulation in this population.…”

Section: Discussionmentioning

confidence: 99%

The Potential Risk Factors for Prolonged Length of Stay Despite an Enhanced Recovery After Surgery Protocol for Elderly Patients Undergoing Short-Level Lumbar Fusion Surgery

Cui

Kong

Wang

et al. 2022

Geriatr Orthop Surg Rehabil

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Objective To identify the risk factors associated with prolonged length of stay (LOS) despite an enhanced recovery after surgery (ERAS) protocol in short-level lumbar fusion surgery. Methods We gathered data for all patients undergoing short-level lumbar fusion surgery from January to November 2021. Given the discharge criteria, a threshold was set according to mean LOS, and two groups were spontaneously formed: LOS shorter than the threshold for discharge (control group, n = 114) and LOS longer or equal to the threshold for discharge (delayed group, n = 72). Preoperative metrics were compared to identify risk factors associated with prolonged LOS. Results A total consecutive 186 patients with complete medical records were enrolled (77 males and 109 females; mean age 71.08 ± 5.70 years). After dichotomization according to the threshold for discharge, there were 114 patients in control group and 72 in delayed group. Statistical analysis demonstrated that age ≥75 years ( P = .002), female sex ( P < .001), American Society of Anesthesiologists grade ≥ 3 ( P = .035), operation time ( P < .001), anesthesia time ( P < .001), ambulation time >1 day ( P = .027), removal of urinary catheter time >1 day ( P = .019), fusion levels ( P < .001), Clavien-Dindo grade > 1 ( P <.001) and allogeneic transfusion ( P = .009) were significantly related to prolonged LOS. Binary logistic regression revealed that age (odds ratio (OR) 5.149; 95% confidence interval (CI) 2.045-12.966, P = .001), sex (OR 5.185, 95% CI 2.183-12.317, P < .001) and Clavien-Dindo grade > 1(OR 15.936, 95% CI 5.220-48.652, P < .001) were independent risk factors of prolonged LOS. Conclusions In this retrospective study, we analyzed the potential risk factors associated with delayed LOS despite implementing ERAS, further, binary logistic regression exhibited that age ≥75 years old, female sex and Clavien-Dindo grade >1 were independently correlated with prolonged LOS.

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Section: Discussionmentioning

confidence: 99%

The Potential Risk Factors for Prolonged Length of Stay Despite an Enhanced Recovery After Surgery Protocol for Elderly Patients Undergoing Short-Level Lumbar Fusion Surgery

Cui

Kong

Wang

et al. 2022

Geriatr Orthop Surg Rehabil

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“…32,33 Increased efficiency within operative techniques and enhanced recovery pathways have reduced hospital duration and improved rehabilitation trajectories for ASD patients. 34,35 However, costs have increased in other areas of procedural care, including instrumentation and biologics. 36 Furthermore, postsurgical complications remain prevalent, and, in the event of postsurgical morbidity, patient outcomes can be compromised and the need for long-term supportive care may still transpire.…”

Section: Discussionmentioning

confidence: 99%

Improvements in Outcomes and Cost after Adult Spinal Deformity Corrective Surgery between 2008 and 2019

Passias¹,

Kummer²,

Imbo³

et al. 2022

Spine

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Study Design. A retrospective cohort study. Objective. To assess whether patient outcomes and cost-effectiveness of adult spinal deformity (ASD) surgery have improved over the past decade.Background. Surgery for ASD is an effective intervention, but one that is also associated with large initial healthcare expenditures. Changes in the cost profile for ASD surgery over the last decade has not been evaluated previously. Materials and Methods. ASD patients who received surgery between 2008 and 2019 were included. Analysis of covariance was used to establish estimated marginal means for outcome measures [complication rates, reoperations, health-related quality of life, total cost, utility gained, quality adjusted life years (QALYs), cost-efficiency (cost per QALY)] by year of initial surgery. Cost was calculated using the PearlDiver database and represented national averages of Medicare reimbursement for services within a 30-day window including length of stay and death differentiated by complication/comorbidity, revision, and surgical approach. Internal cost data was based on individual patient diagnosis-related group codes, limiting revisions to those within two years (2Y) of the initial surgery. Cost per QALY over the course of 2008-2019 were then calculated. Results. There were 1236 patients included. There was an overall decrease in rates of any complication (0.78 vs. 0.61), any reoperation (0.25 vs. 0.10), and minor complication (0.54 vs. 0.37) between 2009 and 2018 (all P < 0.05). National average 2Y cost decreased at an annual rate of $3194 (R 2 = 0.6602), 2Y utility gained increased at an annual rate of 0.0041 (R 2 = 0.57), 2Y QALYs gained increased annually by 0.008 (R 2 = 0.57), and 2Y cost per QALY decreased per year by $39,953 (R 2 = 0.6778). Conclusion. Between 2008 and 2019, rates of complications have decreased concurrently with improvements in patient reported outcomes, resulting in improved cost effectiveness according to national Medicare average and individual patient cost data. The value of ASD surgery has improved substantially over the course of the last decade.

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“…As such, their results should be interpreted with caution with regard to the target patient population. Kim et al also reported on ERAS implementation in spine deformity surgery, comparing it to a historical cohort [28]. e two groups were comparable when it came to demographic data and the magnitude of the deformity using various metrics.…”

Section: Discussionmentioning

confidence: 99%

Enhanced Recovery Pathway in Adults Undergoing Elective Posterior Thoracolumbar Fusion Surgery: Outcomes Compared with a Traditional Care Pathway

Alsaleh

Murrad

Alzakri

et al. 2021

Advances in Orthopedics

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Introduction. Spine fusion surgery is an increasingly popular procedure, but the patient experience is variable and the cost is high. Enhanced recovery after surgery (ERAS) pathways can provide a standardized plan for spine fusion cases, improving quality of care and reducing costs. We report an early attempt at the implementation of such a pathway and compare it to a historical cohort. Methods. All adult patients undergoing elective posterior thoracolumbar spine fusion in 2019 and 2020 were included in the study. The ERAS protocol implementation started in January 2020. The study cohort was all cases performed in 2020—after implementation of ERAS—while the historical cohort was cases from 2019. Demographic and clinical data were collected and compared between the groups. Results. Ninety-three patients were included in the study. The study cohort (ERAS) included 42 patients, while the comparison group (pre-ERAS) included 51 patients. Demographic and preoperative clinical data were similar between the two groups. However, postoperative clinical data showed that ERAS resulted in less reliance on analgesics, earlier mobilization, and a reduced length of stay. Complication and readmission rates were unchanged. Conclusion. ERAS can reduce costs while maintaining or improving clinical outcomes for spinal fusion surgery.

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Enhanced recovery pathway in adult patients undergoing thoracolumbar deformity surgery

Cited by 22 publications

References 36 publications

The Potential Risk Factors for Prolonged Length of Stay Despite an Enhanced Recovery After Surgery Protocol for Elderly Patients Undergoing Short-Level Lumbar Fusion Surgery

The Potential Risk Factors for Prolonged Length of Stay Despite an Enhanced Recovery After Surgery Protocol for Elderly Patients Undergoing Short-Level Lumbar Fusion Surgery

Improvements in Outcomes and Cost after Adult Spinal Deformity Corrective Surgery between 2008 and 2019

Enhanced Recovery Pathway in Adults Undergoing Elective Posterior Thoracolumbar Fusion Surgery: Outcomes Compared with a Traditional Care Pathway

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