Conference Proceeding - Restricted Access
BACKGROUND CONTEXTEnhanced 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).
PURPOSEThe 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/SETTINGRetrospective Study, Single Institution.
PATIENT SAMPLEPatients undergoing instrumented lumbar fusion.
OUTCOME MEASURESLOS, MME, Pain score, Time to ambulation, discharge disposition and readmission.
METHODSPatients 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).
RESULTSA 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).
CONCLUSIONSPatients 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.
Easton RW, Lipphardt M, Papakonstantinou NS, Silvasi D, Smith G, Chen NW, et al. [Vibert B, Pestano C]. ERAS protocol associated with improved measurable outcomes in patients undergoing lumbar spinal fusion. Spine J. 2022 Sep;22(9 Suppl):S158. doi:10.1016/j.spinee.2022.07.023.