Document Type

Conference Proceeding - Restricted Access

Publication Date

9-2022

Publication Title

Spine Journal

Abstract

BACKGROUND CONTEXT

Enhanced Recovery After Surgery (ERAS) has been proven to improve clinical outcomes in other major and complex surgeries. Preoperative optimization, multi-modal pain management and preemptive treatment to prevent most common postoperative conditions are key components. In addition, “fast track” protocol strategies (ie, early nutrition, drain removal and ambulation, etc) are believed to facilitate faster recovery and discharge. Shortened length of stay (LOS) has been associated with improved patient satisfaction and an important hospital cost-saving measure. However, concerns have been raised if shorter length of stay has unintended cost-consequences by shifting care from in-patient to post-discharge care (ie, use of rehab centers, home health care or increased hospital readmission).

PURPOSE

The authors sought to evaluate the impact of newly implemented ERAS protocol in measurable clinical outcomes and its consequence with regards to hospital readmission and identify any post-discharge care substitution.

STUDY DESIGN/SETTING

Retrospective Study, Single Institution.

PATIENT SAMPLE

Patients undergoing instrumented lumbar fusion.

OUTCOME MEASURES

LOS, MME, Pain score, Time to ambulation, discharge disposition and readmission.

METHODS

Patients undergoing lumbar spine surgery from Jan-Dec 2018 were included in this retrospective case series. Patient characteristics, surgical time and events, ambulation, Numeric Rating Scale (pain score 0 means no pain, 10 worst pain possible), LOS, discharge disposition and readmission were compared between a group treated under the new ERAS protocol (ERAS) and a control group treated prior to protocol implementation (Pre-ERAS). All opioids administered were collected and doses converted to morphine milligram equivalent (MME). Data was analyzed with t-test (or Kruskal-Wallis test) and Chi-squared test (Fisher's exact test).

RESULTS

A total of 338 patients were included in this analysis (146 ERAS, 192 Pre-ERAS). Patients during the protocol trial period were excluded. Both groups were similar in characteristics: age at surgery, gender, BMI, ASA score and baseline opioid use (all p>0.05). Preoperative baseline pain scores were comparable between ERAS vs Pre-ERAS groups (4.50 vs 4.20, p=0.401). Postoperatively, patients in the ERAS group reported lower average pain scores in recovery room (5.22 vs 6.03, p=0.004); and surgical unit at 0-24 hours (4.70 vs 5.07, p= 0.055), at 24-48 hours (4.11 vs 4.76, p80%). Transfer to sub-acute rehabilitation (16.44% vs 18.75%, p=0.58) and hospital readmission were comparable (6.85% vs 6.25%, p=.082).

CONCLUSIONS

Patients treated under a newly implemented ERAS protocol were observed to have lower pain scores, less opioid consumption, early ambulation and shorter hospitalization. No significant post-discharge care substitution was observed; discharge disposition and hospital readmission were comparable.

Volume

22

Issue

9 Suppl

First Page

S158

Comments

North American Spine Society 37th Annual Meeting, October 12-15, 2022, Chicago, IL.

DOI

10.1016/j.spinee.2022.07.023

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