197. Modest cost reduction associated with initial ERAS implementation in lumbar spine fusion
The Spine Journal
Key principles of enhanced recovery after surgery (ERAS) protocols include preoperative optimization; prophylaxis treatment of common postoperative conditions (anemia, infection, nausea and vomiting); patient education, anesthesia and multimodal analgesia standardization, blood loss prevention, and other evidenced-based approaches aimed at improving outcomes. Relative to standard of care, implementing ERAS protocol's comprehensive preoperative risk assessment, formal patient education and administration of preemptive interventions require additional costly hospital supplies and resources. Although ERAS has been previously shown to decrease length of stay (LOS), its economic impact during initial implementation is not widely known, specifically in spine surgery.
The authors sought to study the economic benefits of ERAS implementation in lumbar spine fusion.
Patients undergoing lumbar spine fusion.
Hospital cost per patient: variable direct cost, indirect cost net income.
A new ERAS spine protocol was implemented in a 520-bed hospital. After IRB approval, consecutive patients who underwent lumbar fusion 6 months before (pre-ERAS group) and 6 months after protocol implementation (ERAS group) were identified. The two groups were compared in terms of demographics, surgery, length of stay (LOS), per patient variable direct costs (labor, medications, and supplies), indirect costs (utilities, information technology support, administrative resources) and net income. Comparisons between arms on characteristics of the study population were done by t-tests (or nonparametric analysis of Wilcoxon/Kruskal-Wallis) for continuous variables and by chi-squared tests (or Fisher exact tests) for categorical variables.
A total of 338 lumbar fusion patients were comparable in age, gender and BMI (all p>0.05). There were more primary than revision surgery (p=0.03); the number of operated spinal levels between the two groups were similar (p=0.86). With regard to variable direct costs, the average total labor cost per patient (nursing, technician, nurse anesthetist and allied services) was higher in the pre-ERAS group ($2,848.7 vs $3,255.5, p
ERAS protocol implementation in lumbar fusion at authors' institution led to shortened LOS, modestly reducing variable direct and indirect costs. Prophylactic treatment of common postoperative conditions and treatment protocol standardization likely contributed to the cost reduction of administered medications. Discussion: as more institutions implement ERAS, experience and knowledge are gained. To determine what constitutes the best mix of cost-effective ERAS interventions are clinically meaningful for spine surgery, further study is warranted.
Pestano C, Easton RW, Ahlgren B, Vibert B, Papakonstantinou NS, Lipphardt M, Silvasi D, Smith G, Chen N. 197. Modest cost reduction associated with initial ERAS implementation in lumbar spine fusion. The Spine Journal [Internet]. 2021;21(9):S100-S100. Available from: https://doi.org/10.1016/j.spinee.2021.05.404