Pre-optimization of spinal surgery patients: Development of a neurosurgical enhanced recovery after surgery (ERAS) protocol

Ali, Zarina S.; Tracy, S.; Öztürk, Ali; Malhotra, Neil R.; Schuster, James M.; Marcotte, Paul J.; Grady, M. Sean; Welch, William C.

doi:10.1016/j.clineuro.2017.12.003

Cited by 103 publications

(110 citation statements)

References 123 publications

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“…Enhanced recovery after spine surgery is still in its in-fancy, having been evaluated in only a limited number of studies to date. 1,8,24,25 The ability to modify patient experience and outcome based on a multimodality approach is the cornerstone of the ERAS philosophy. Some reports of ERAS in spine have focused on perioperative strategies, while Wang et al chose to develop their initial ERAS pathway around minimally invasive surgery to reduce surgical stress.…”

Section: Discussionmentioning

confidence: 99%

Enhanced perioperative care and decreased cost and length of stay after elective major spinal surgery

Carr

Saigal

Zhang

et al. 2019

Neurosurgical Focus

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OBJECTIVEThe purpose of this study was to compare total cost and length of stay (LOS) between spine surgery patients enrolled in an enhanced perioperative care (EPOC) pathway and patients receiving traditional perioperative care (TRDC).METHODSAll spine surgery candidates were screened for inclusion in the EPOC pathway. This cohort was compared to a retrospective cohort of patients who received TRDC and a concurrent group of patients who met inclusion criteria but did not receive the EPOC (no pathway care [NOPC] group). Direct and indirect costs as well as hospital and intensive care LOSs were analyzed between the 3 groups.RESULTSTotal costs after pathway implementation decreased by $19,344 in EPOC patients compared to a historical cohort of patients who received TRDC and $5889 in a concurrent cohort of patients who did not receive EPOC (NOPC group). Hospital and intensive care LOS were significantly lower in EPOC patients compared to TRDC and NOPC patients.CONCLUSIONSThe implementation of a multimodal EPOC pathway decreased LOS and cost in major elective spine surgeries.

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Section: Discussionmentioning

confidence: 99%

Enhanced perioperative care and decreased cost and length of stay after elective major spinal surgery

Carr

Saigal

Zhang

et al. 2019

Neurosurgical Focus

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“…To date, there have been few peer-reviewed publications regarding spine ERAS programs that have actually been implemented. 1,2,8,[11][12][13][14] Given that spinal fusion surgeries can be painful, morbid, and costly, the implementation of a spine ERAS program would be a major advancement in the field. In an effort to develop evidence-driven protocols for ERAS, we embarked on a quality improvement project to address the challenges spinal surgeons face in the postoperative period.…”

mentioning

confidence: 99%

Reductions in length of stay, narcotics use, and pain following implementation of an enhanced recovery after surgery program for 1- to 3-level lumbar fusion surgery

Brusko¹,

Kolcun²,

Heger³

et al. 2019

Neurosurgical Focus

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OBJECTIVELumbar fusion is typically associated with high degrees of pain and immobility. The implementation of an enhanced recovery after surgery (ERAS) approach has been successful in speeding the recovery after other surgical procedures. In this paper, the authors examined the results of early implementation of ERAS for lumbar fusion.METHODSBeginning in March 2018 at the authors’ institution, all patients undergoing posterior, 1- to 3-level lumbar fusion surgery by any of 3 spine surgeons received an intraoperative injection of liposomal bupivacaine, immediate single postoperative infusion of 1-g intravenous acetaminophen, and daily postoperative visits from the authors’ multidisciplinary ERAS care team. Non–English- or non–Spanish-speaking patients and those undergoing nonelective or staged procedures were excluded. Reviews of medical records were conducted for the ERAS cohort of 57 patients and a comparison group of 40 patients who underwent the same procedures during the 6 months before implementation.RESULTSGroups did not differ significantly with regard to sex, age, or BMI (all p > 0.05). Length of stay was significantly shorter in the ERAS cohort than in the control cohort (2.9 days vs 3.8 days; p = 0.01). Patients in the ERAS group consumed significantly less oxycodone-acetaminophen than the controls on postoperative day (POD) 0 (408.0 mg vs 1094.7 mg; p = 0.0004), POD 1 (1320.0 mg vs 1708.4 mg; p = 0.04), and POD 3 (1500.1 mg vs 2105.4 mg; p = 0.03). Postoperative pain scores recorded by the physical therapy and occupational therapy teams and nursing staff each day were lower in the ERAS cohort than in controls, with POD 1 achieving significance (4.2 vs 6.0; p = 0.006). The total amount of meperidine (8.8 mg vs 44.7 mg; p = 0.003) consumed was also significantly decreased in the ERAS group, as was ondansetron (2.8 mg vs 6.0 mg; p = 0.02). Distance ambulated on each POD was farther in the ERAS cohort, with ambulation on POD 1 (109.4 ft vs 41.4 ft; p = 0.002) achieving significance.CONCLUSIONSIn this very initial implementation of the first phase of an ERAS program for short-segment lumbar fusion, the authors were able to demonstrate substantial positive effects on the early recovery process. Importantly, these effects were not surgeon-specific and could be generalized across surgeons with disparate technical predilections. The authors plan additional iterations to their ERAS protocols for continued quality improvements.

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“…Considering the high incidence of complications in spine surgery, during the last years several authors focused their attention on the risk factors related to the onset of complications and on predictive models of complications after spine surgery [12][13][14][15][16]. Moreover, several preventive measures have been studied and recently described in order to reduce complications in spine surgery, concerning intraoperative neuromonitoring, blood loss reduction, and infections and thrombosis prophylaxis [19][20][21][22][23]. Sethi et al [24] reported their experience concerning the application of Lean methodology in orthopedic surgery and specifically in spine surgery.…”

Section: Preventive Measures To Improve Safety: the Who Surgical Safementioning

confidence: 99%

“…In spinal surgery, many preventive measures were investigated to reduce complications [19][20][21][22][23][24], but there is no report on the effectiveness of the WHO checklist in reducing complications.…”

Section: Introductionmentioning

confidence: 99%

Spinal surgery complications: an unsolved problem—Is the World Health Organization Safety Surgical Checklist an useful tool to reduce them?

et al. 2019

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Purpose To investigate whether the World Health Organization Safety Surgical Checklist (SSC) is an effective tool to reduce complications in spinal surgery. Methods We retrospectively evaluated the clinical and radiological charts prospectively collected from patients who underwent a spinal surgery procedure from January 2010 to December 2012. The aim of this study was to compare the incidence of complications between two periods, from January to December 2010 (without checklist) and from January 2011 and December 2012 (with checklist), in order to assess the checklist's effectiveness. Results The sample size was 917 patients with an average of 30-month follow-up. The mean age was 52.88 years. The majority of procedures were performed for oncological diseases (54.4%) and degenerative diseases (39.8%). In total, 159 complications were detected (17.3%). The overall incidence of complications for trauma, infectious pathology, oncology, and degenerative disease was 22.2%, 19.2%, 18.4%, and 15.3%, respectively. No correlation was observed between the type of pathology and the complication incidence. We observed a reduction in the overall incidence of complications following the introduction of the SSC: In 2010 without checklist, the incidence of complications was 24.2%, while in 2011 and 2012, following the checklist introduction, the incidence of complications was 16.7% and 11.7%, respectively (mean 14.2%). Conclusions The SSC seems to be an effective tool to reduce complications in spinal surgery. We propose to extend the use of checklist system also to the preoperative and postoperative phases in order to further reduce the incidence of complications.

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Pre-optimization of spinal surgery patients: Development of a neurosurgical enhanced recovery after surgery (ERAS) protocol

Cited by 103 publications

References 123 publications

Enhanced perioperative care and decreased cost and length of stay after elective major spinal surgery

Enhanced perioperative care and decreased cost and length of stay after elective major spinal surgery

Reductions in length of stay, narcotics use, and pain following implementation of an enhanced recovery after surgery program for 1- to 3-level lumbar fusion surgery

Spinal surgery complications: an unsolved problem—Is the World Health Organization Safety Surgical Checklist an useful tool to reduce them?

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