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Design and Implementation of an Enhanced Recovery After Surgery (ERAS) Program for Minimally Invasive Lumbar Decompression Spine Surgery

Initial Experience

Soffin, Ellen M., MD; Vaishnav, Avani S., MBBS; Wetmore, Douglas S., MD; Barber, Lauren, MD; Hill, Patrick, MD; Gang, Catherine Himo, MPH; Beckman, James D., MD; Albert, Todd J., MD∗,†; Qureshi, Sheeraz A., MD, MBA∗,†

doi: 10.1097/BRS.0000000000002905

Study Design. A retrospective cohort study of prospectively collected data.

Objective. The aim of this study was to describe the development of and early experience with an evidence-based enhanced recovery after surgery (ERAS) pathway for lumbar decompression.

Summary of Background Data. ERAS protocols have been consistently associated with improved patient experience and outcomes, and reduced cost and length of hospital stay (LoS). Despite successes in other orthopedic subspecialties, ERAS has yet to be established in spine surgery. Here, we report the development of and initial experience with the first comprehensive ERAS pathway for MIS lumbar spine surgery.

Methods. An evidence-based review of the literature was performed to select components of the ERAS pathway. The pathway was applied to 61 consecutive patients presenting for microdiscectomy or lumbar laminotomy/laminectomy between dates. Data collection was performed by review of the electronic medical record. We evaluated compliance with individual ERAS process measures, and adherence to the overall pathway. The primary outcome was LoS. Demographics, comorbidities, perioperative course, prevalence of opioid tolerance, and factors affecting LoS were also documented.

Results. The protocol included 15 standard ERAS elements. Overall pathway compliance was 85.03%. Median LoS was 279 minutes [interquartile range (IQR) 195–398 minutes] overall, 298 minutes (IQR 192–811) for lumbar decompression and 285 minutes (IQR 200–372) for microdiscectomy. There was no correlation between surgical subtype or duration and LoS. Overall, 37% of the cohort was opioid-tolerant at the time of surgery. There was no significant effect of baseline opioid use on LoS, or on the total amount of intraoperative or PACU opioid administration. There were four complications (6.5%) resulting in extended LoS (>23 hours).

Conclusion. This report comprises the first description of a comprehensive, evidence-based ERAS for spine pathway, tailored for lumbar decompression/microdiscectomy resulting in short LoS, minimal complications, and no readmissions within 90 days of surgery.

Level of Evidence: 3

Enhanced recovery after surgery (ERAS) is a set of guidelines focused on perioperative care promoting optimal recovery after surgery. These protocols have led to significant clinical and economic gains in various fields. Here, we describe the development of and early experience with an evidence-based ERAS pathway for lumbar decompression.

Hospital for Special Surgery, New York, NY

Weill Cornell Medical College, New York, NY.

Address correspondence and reprint requests to Sheeraz A. Qureshi, MD, MBA, 535 E. 70th St., New York, NY 10021; E-mail: qureshis@HSS.EDU.

Received 27 June, 2018

Revised 15 August, 2018

Accepted 14 September, 2018

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, consultancy, royalties, stocks, grants, employment.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.