The application of an enhanced recovery after spine surgery to lumbar instrumentation

Abstract

AIM: To evaluate the clinical and economic outcomes of the adoption of the enhanced recovery after spine surgery (ERSS) program in patients undergoing spine instrumentation. MATERIAL and METHODS: This study described the introduction of the ERSS program, and we compared 86 consecutive patients who participated in ERSS with a retrospective cohort of 88 patients who underwent the same surgery before the implementation of this program. Groups were compared in terms of age, sex, body mass index (BMI), American Society of Anesthesiologist (ASA) physical scores, operative time, comorbidities, intraoperative blood loss, blood transfusion rate, first oral intake, time of first mobilization, length of hospital stay, preoperative and postoperative pain scores using a numeric pain rating scale, 30-day readmission and complication rates, and total cost. RESULTS: Groups were similar in terms of age, sex, BMI, ASA scores, and comorbidities. Intraoperative blood loss, blood transfusion rate, and length of hospital stay were lower in the ERSS group. First oral intake and first mobilization occurred earlier in the ERSS group. Postoperative pain scores were significantly lower in the ERSS group. Operative time, readmissions, or complications at 30 days did not statistically differ between the two groups. The ERSS group was found to be significantly cost effective. CONCLUSION: ERSS is feasible, comprehensive, and cost effective for spine instrumentation with better perioperative outcomes.

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.…”

“…The amount of opioids ingested or prescribed was calculated by converting to morphine milligram equivalents (MME) using standard conversion formulas. 17 , 18 , 19 , 20 Although there is some debate as to whether tramadol is an opioid, the FDA defines it as such and thus it was factored into the calculation of total opioid use. 21 A subanalysis of patients who received only tramadol was performed.…”