ERAS Protocols for Elective Spine Surgery: A Retrospective Review

Abstract

Research Question: Do adults undergoing elective spine surgery in the two years following the implementation of our new ERAS protocol (July 2018 ¿ March 2020) demonstrate better clinical outcomes compared to patients treated using our original ERAS protocol? Furthermore, do these cohorts differ quantitatively in (1) thirty-day hospital readmission rates, (2) ninety-day postoperative infection rates, and (3) hospital length of stay?

Background and Significance: The Enhanced Recovery After Surgery (ERAS) program has shown its utility in reducing the hospital length of stay (LOS). ERAS has been established in surgical specialties nationwide, but few studies have been directed at spine surgery. It was only recently that ERAS protocols were outlined for their use in spine surgery. The goal of the study is to evaluate the result of recent changes to the ERAS protocol on patient outcomes.

Materials and Methods: This retrospective case-control study reviewed electronic medical records of neurosurgical patients at a quaternary referral center for trends and variances. The analysis focused on the recent changes (the addition of a multimodal analgesic regimen (MAR) and preoperative high-carbohydrate drink (HCD) to our ERAS protocol (July 2018- March 2020). Using IBM SPSS version 27, parametric and nonparametric analyses were conducted to assess for differences in infection rates, hospital length of stay (LOS), and readmission rates.

Results: A between-subjects t-test was utilized to compare the LOS between the BEFORE group and the AFTER group in hours. The BEFORE group (M = 68.45, SD = 58.08) spent significantly more hours in the hospital than the AFTER group (M = 62.22, SD = 52.36), t (3264) = 3.19, p < .001. However, the effect of the difference was small (d = .18).

Conclusion: While many studies have validated the differences between ERAS and non-ERAS cohorts, fewer studies have described modifications of already established ERAS protocols in patients undergoing elective spine surgeries. Changing two components to a complex protocol resulted in a statistically significant reduction in LOS between the BEFORE and AFTER groups. Broad application of these modifications will likely result in better patient satisfaction scores and more prudent utilization of resources.