scholarly journals Enhanced recovery after surgery (ERAS) program for elderly patients with short-level lumbar fusion

2020 ◽  
Author(s):  
Peng Wang ◽  
Qiang Wang ◽  
Chao Kong ◽  
Ze Teng ◽  
Zhongen Li ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Elderly Patients ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Lumbar Fusion ◽  
Japanese Orthopaedic Association ◽  
Visual Analogue Score ◽  
Japanese Orthopaedic Association Score ◽  
Oswestry Disability Index Score ◽  
Surgery Group

Abstract Background: Degenerative disorders of the lumbar spine decrease the mobility and quality of life of elderly patients. Lumbar fusion surgery is the primary method of treating degenerative lumbar spine disorders; however, the surgical stress response associated with major surgery has been linked to pathophysiological changes in the elderly, resulting in undesirable postoperative morbidity, complications, pain, fatigue, and extended convalescence. In the present study, we aimed to determine whether enhanced recovery after surgery significantly improved satisfaction and outcomes in elderly patients (>65 years old) with short-level lumbar fusion. Methods: A total of 192 patients were included, 96 in the enhanced recovery after surgery group and 96 case-matched patients in the non- enhanced recovery after surgery group. Data including demographic, comorbidity and surgical information were collected from electronic medical records. enhanced recovery after surgery interventions were categorised as preoperative, intraoperative and postoperative. We also evaluated primary outcome, surgical complication, length of stay, postoperative pain scores and 30-day readmission rates. Results: There were no statistically significant intergroup differences in regards to demographics, comorbidities、American Society of Anaesthesiologists grade、or the number of fusion levels. There were also no differences between mean surgery time of intraoperative blood loss between the enhanced recovery after surgery and non- enhanced recovery after surgery groups. In addition, the mean preoperative Japanese Orthopaedic Association score、Visual Analogue Score for the back and legs and Oswestry Disability Index score were not significantly different between the two groups. Overall, enhanced recovery after surgery pathway compliance was 92.1%. There were no significant differences in the number of complications or the mortality rates between the enhanced recovery after surgery and non- enhanced recovery after surgery groups. Furthermore, the mean postoperative Japanese Orthopaedic Association score、Visual Analogue Score for the back and legs, Oswestry Disability Index score and readmission rates score revealed no significant differences between the groups at 30-day- follow-up point. However, we observed a statistically significant decrease in length of stay in the enhanced recovery after surgery group (12.30±3.03 of enhanced recovery after surgery group versus 15.50±1.88 in non- enhanced recovery after surgery group, p=0). Multivariable linear regression showed that comorbidities (p=0.023) and implementation of enhanced recovery after surgery program (p=0.002) were correlated with prolonged length of stay. Multivariable logistic regression showed that no characteristics were associated with complications. Conclusions: This report describes the first enhanced recovery after surgery protocol used in elderly patients after short-level lumbar fusion surgery. Our enhanced recovery after surgery program is safe and could help decreases length of stay in elderly patients with short-level lumbar fusion.

scholarly journals Enhanced Recovery After Surgery (Eras) Program for Elderly Patients With Short-level Lumbar Fusion

2020 ◽  
Author(s):  
Peng Wang ◽  
Qiang Wang ◽  
Chao Kong ◽  
Ze Teng ◽  
Zhongen Li ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Surgical Stress ◽  
Lumbar Fusion ◽  
Japanese Orthopaedic Association ◽  
Group Versus ◽  
Major Surgery ◽  
Fusion Surgery ◽  
The Mean

Abstract Background:Degenerative disorders of the lumbar spinedecrease the mobility and quality of life of elderly patients.Lumbar fusion surgery is the primary methodof treating degenerative lumbar spine disorders; however, the surgical stress response associated with major surgery has been linked to pathophysiological changes in the elderly,resulting in undesirable postoperative morbidity, complications, pain, fatigue, and extended convalescence. In the present study, we aimed to determine whether enhanced recovery after surgery (ERAS) significantly improvedsatisfaction and outcomes in elderly patients(>65 years old) with short-level lumbar fusion.Methods:A total of 192 patients were included, 96 in the ERAS group and 96 case-matched patients in the non-ERAS group.Data including demographic, comorbidity and surgical informationwere collected from electronic medical records. ERAS interventionswere categorisedas preoperative,intraoperative and postoperative. We also evaluated primary outcome,surgicalcomplication, length of stay (LOS), postoperative pain scores and 30-day readmissionrates.Results:There were no statistically significant intergroup differences in regards to demographics, comorbidities、American Society of Anaesthesiologists (ASA) grade、or the number of fusion levels. There were also no differences between mean surgery time of intraoperative blood loss between the ERAS and non-ERAS groups. In addition, the mean preoperative Japanese Orthopaedic Association (JOA) score、Visual Analogue Score (VAS) for the back and legs and Oswestry Disability Index (ODI) score were not significantly different between the two groups. Overall, ERAS pathway compliance was 92.1%. There were no significant differences inthe number of complicationsor themortality rates between the ERAS and non-ERAS groups. Furthermore, the mean postoperative JOA score、VAS for the back and legs,ODI and readmission ratesscore revealed no significant differencesbetween the groups at 30-day- follow-up point. However, we observed a statistically significant decrease in LOS in the ERAS group (12.30±3.03 of ERAS group versus 15.50±1.88 in non-ERAS group, p=0).Multivariable linear regression showed thatcomorbidities (p=0.023) and implementation of ERAS program (p=0.002) were correlated with prolonged LOS.Multivariable logistic regression showed that no characteristics were associated with complications.Conclusions:This report describes the first ERAS protocol used in elderly patients after short-level lumbar fusion surgery. Our ERAS program is safe and could help decreases LOS in elderly patients with short-level lumbar fusion.

scholarly journals Enhanced Recovery After Surgery (ERAS) Program for Elderly Patients With Long-level Lumbar Fusion

2021 ◽  
Author(s):  
PENG WANG ◽  
CHAO KONG ◽  
ZE TENG ◽  
ZHONGEN LI ◽  
SITAO ZHANG ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Surgical Stress ◽  
Surgical Complication ◽  
Lumbar Fusion ◽  
Group Versus ◽  
Visual Analogue Score ◽  
Lessons Learned ◽  
American Society

Abstract Background: Currently, ERAS for spinal surgery field is still in its beginnings, the major protocol lessons learned from other surgical specialties and lack of ERAS program for elderly patients (>70 years old). Geriatric patients has its own special characteristics resulting in more harmed by surgical stress. The enhanced recovery after surgery (ERAS) are designed to improving recovery after surgery and can result in substantial benefits in both clinical outcomes and cost-effectiveness. In the present study, we aimed to determine whether enhanced recovery after surgery (ERAS) significantly improved satisfaction and outcomes in elderly patients (>70 years old) with long-level lumbar fusion. Methods: A total of 144 patients were included, 62 in the ERAS group and 82 case-matched patients in the non-ERAS group. Data including demographic, comorbidity and surgical information were collected from electronic medical records. ERAS interventions were categorised as preoperative, intraoperative and postoperative. We also evaluated primary outcome, surgical complication and length of stay (LOS).Results: There were no statistically significant intergroup differences in regards to demographics, comorbidities、American Society of Anaesthesiologists (ASA) grade、or the number of fusion levels. There were also no differences between mean surgery time of intraoperative blood loss between the ERAS and non-ERAS groups. In addition, the mean preoperative Visual Analogue Score (VAS) for the back and legs and Oswestry Disability Index (ODI) score were not significantly different between the two groups. Overall, ERAS pathway compliance was 91.5%. There were no significant differences in the mortality rates between the ERAS and non-ERAS groups. However, we observed a statistically significant decrease in the complications in the ERAS group(6 in the ERAS group versus 23 in the non-ERAS group, p=0.006) and LOS in the ERAS group (17.74±5.56 of ERAS group versus 22.13±12.21 in non-ERAS group, p=0.041). Multivariable linear regression showed that comorbidities (p=0.028) and implementation of ERAS program (p=0.002) were correlated with prolonged LOS. Multivariable logistic regression showed that comorbidities (p=0.029)， implementation of ERAS program (p=0.043) and preoperative VAS Back (p=0.046), were correlated with complications. Conclusions: This report describes the first ERAS protocol used in elderly patients after long-level lumbar fusion surgery. Our ERAS program is safe and could help decreases LOS and complication in elderly patients with long-level lumbar fusion.

scholarly journals Retrospective Data Analysis for Enhanced Recovery after Surgery (ERAS) Protocol for Elderly Patients with Long-Level Lumbar Fusion

2021 ◽  
Author(s):  
PENG WANG ◽  
CHAO KONG ◽  
ZE TENG ◽  
ZHONGEN LI ◽  
SITAO ZHANG ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Surgical Stress ◽  
Surgical Complication ◽  
Lumbar Fusion ◽  
Group Versus ◽  
Visual Analogue Score ◽  
Lessons Learned ◽  
Eras Protocol

Abstract Background: Currently, ERAS for spinal surgery field is still in its beginnings, the major protocol lessons learned from other surgical specialties and lack of ERAS program for elderly patients (>70 years old). Geriatric patients has its own special characteristics resulting in more harmed by surgical stress. The enhanced recovery after surgery (ERAS) are designed to improving recovery after surgery and can result in substantial benefits in both clinical outcomes and cost-effectiveness. In the present study, we aimed to determine whether enhanced recovery after surgery (ERAS) significantly improved satisfaction and outcomes in elderly patients (>70 years old) with long-level lumbar fusion. Methods: A total of 154 patients were included, 72 in the ERAS group and 82 case-matched patients in the non-ERAS group. Data including demographic, comorbidity and surgical information were collected from electronic medical records. ERAS interventions were categorised as preoperative, intraoperative and postoperative. We also evaluated primary outcome, surgical complication and length of stay (LOS).Results: There were no statistically significant intergroup differences in regards to demographics, comorbidities, American Society of Anaesthesiologists (ASA) grade, or the number of fusion levels. There were also no differences between mean surgery time of intraoperative blood loss between the ERAS and non-ERAS groups. In addition, the mean preoperative Visual Analogue Score (VAS) for the back and legs and Oswestry Disability Index (ODI) score were not significantly different between the two groups. Overall, ERAS pathway compliance was 91.5%. There were no significant differences in the readmission and mortality rates at 30-day follow-up between the ERAS and non-ERAS groups. However, we observed a statistically significant decrease in the complications in the ERAS group(8 in the ERAS group versus 23 in the non-ERAS group, p=0.009) and LOS in the ERAS group (17.74±5.56 of ERAS group versus 22.13±12.21 in non-ERAS group, p=0.041). Multivariable linear regression showed that comorbidities (p=0.028) and implementation of ERAS program (p=0.002) were correlated with prolonged LOS. Multivariable logistic regression showed that comorbidities (p=0.029)， implementation of ERAS program (p=0.043) and preoperative VAS Back (p=0.046), were correlated with complications. Conclusions: This report describes the first ERAS protocol used in elderly patients after long-level lumbar fusion surgery. Our ERAS program is safe and could help decreases LOS and complication in elderly patients with long-level lumbar fusion.

Fast-Track Pancreaticoduodenectomy in the Elderly

2017 ◽  
Vol 83 (3) ◽  
pp. 239-249 ◽  
Author(s):  
Efstratios Zouros ◽  
Theodoros Liakakos ◽  
Anastasios Machairas ◽  
Paulos Patapis ◽  
Helen Tzerbinis ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Elderly Patients ◽  
Fast Track ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
The Elderly ◽  
Readmission Rates ◽  
Eras Protocol ◽  
Complex Surgery ◽  
Program Data

It remains uncertain whether enhanced recovery after surgery (ERAS) protocols can be safely implemented for elderly patients, especially after highly complex surgery such as pancreaticoduodenectomy (PD). The present study was designed to assess the feasibility and safety of an ERAS protocol in elderly patients undergoing PD. Starting January 2010 to February 2015, we prospectively collected data from 85 consecutive patients who underwent PD with a fast-track program. Data of patients older and younger than 70 years were compared. Endpoints were morbidity, mortality, readmissions, length of stay, and compliance with ERAS elements. Forty-five patients were less than 70 years old and 40 patients were 70 years of age or older. Both mortality (4.4% vs 5%; P = 1.000) and overall morbidity (33.3% vs 37.5%; P = 0.821) did not differ significantly between the groups. Rates of intervention and relaparotomy were similar in both groups. Length of stay (10 vs 11.8 days; P = 0.099) did not differ significantly between the groups, nor did the readmission rates (6.7% vs 5.0%; P = 0.272). There were no differences in compliance with ERAS elements between groups. An ERAS program seems feasible and can be safely implemented for elderly patients undergoing PD.

scholarly journals 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

2019 ◽  
Vol 46 (4) ◽  
pp. E4 ◽  
Author(s):  
G. Damian Brusko ◽  
John Paul G. Kolcun ◽  
Julie A. Heger ◽  
Allan D. Levi ◽  
Glen R. Manzano ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Lumbar Fusion ◽  
Recovery Process ◽  
Early Recovery ◽  
Fusion Surgery ◽  
Positive Effects ◽  
Lumbar Fusion Surgery ◽  
Early Implementation

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.

Length of stay in enhanced recovery after surgery in children

2021 ◽  
Vol 38 (7) ◽  
pp. 796-797
Author(s):  
Rita Assaker ◽  
Charlotte Fait ◽  
Florence Julien-Marsollier ◽  
Salim Idelcadi ◽  
Farid Houmaida ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery
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