scholarly journals Improving recovery after elective degenerative spine surgery: 5-year experience with an enhanced recovery after surgery (ERAS) protocol

2019 ◽  
Vol 46 (4) ◽  
pp. E7 ◽  
Author(s):  
Victor E. Staartjes ◽  
Marlies P. de Wispelaere ◽  
Marc L. Schröder
Keyword(s):  
Adverse Events ◽  
Hospital Stay ◽  
Spine Surgery ◽  
Surgical Procedures ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Perioperative Outcomes ◽  
Degenerative Spine ◽  
Concomitant Decrease ◽  
Eras Protocol

OBJECTIVEEnhanced recovery after surgery (ERAS) has led to a paradigm shift in various surgical specialties. Its application can result in substantial benefits in perioperative healthcare utilization through preoperative physical and mental patient optimization and modulation of the recovery process. Still, ERAS remains relatively new to spine surgery. The authors report their 5-year experience, focusing on ERAS application to a broad population of patients with degenerative spine conditions undergoing elective surgical procedures, including anterior lumbar interbody fusion (ALIF).METHODSA multimodal ERAS protocol was applied between November 2013 and October 2018. The authors analyze hospital stay, perioperative outcomes, readmissions, and adverse events obtained from a prospective institutional registry. Elective tubular microdiscectomy and mini-open decompression as well as minimally invasive (MI) anterior or posterior fusion cases were included. Their institutional ERAS protocol contains 22 pre-, intra-, and postoperative elements, including preoperative patient counseling, MI techniques, early mobilization and oral intake, minimal postoperative restrictions, and regular audits.RESULTSA total of 2592 consecutive patients were included, with 199 (8%) undergoing fusion. The mean hospital stay was 1.1 ± 1.2 days, with 20 (0.8%) 30-day and 36 (1.4%) 60-day readmissions. Ninety-four percent of patients were discharged after a maximum 1-night hospital stay. Over the 5-year period, a clear trend toward a higher proportion of patients discharged home after a 1-night stay was observed (p < 0.001), with a concomitant decrease in adverse events in the overall cohort (p = 0.025) and without increase in readmissions. For fusion procedures, the rate of 1-night hospital stays increased from 26% to 85% (p < 0.001). Similarly, the average length of hospital stay decreased steadily from 2.4 ± 1.2 days to 1.5 ± 0.3 days (p < 0.001), with a notable concomitant decrease in variance, resulting in an estimated reduction in nursing costs of 46.8%.CONCLUSIONSApplication of an ERAS protocol over 5 years to a diverse population of patients undergoing surgical procedures, including ALIF, for treatment of degenerative spine conditions was safe and effective, without increase in readmissions. The data from this large case series stress the importance of the multidisciplinary, iterative improvement process to overcome the learning curve associated with ERAS implementation, and the importance of a dedicated perioperative care team. Prospective trials are needed to evaluate spinal ERAS on a higher level of evidence.

scholarly journals Enhanced recovery after surgery (ERAS) protocol reduces LOS without additional adverse events in spine surgery

2020 ◽  
Vol 106 (6) ◽  
pp. 1167-1173
Author(s):  
Henri d’Astorg ◽  
Vincent Fière ◽  
Maud Dupasquier ◽  
Thais Dutra Vieira ◽  
Marc Szadkowski
Keyword(s):  
Adverse Events ◽  
Spine Surgery ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Eras Protocol

scholarly journals AB047. Audit of enhanced recovery after surgery (ERAS) protocol for elective colorectal surgical procedures

2020 ◽  
Vol 4 ◽  
pp. AB047-AB047
Author(s):  
Syed Mohammad Umar Kabir ◽  
Huilun Huan ◽  
Jing Ting Cheah ◽  
Shenelle Samodee ◽  
Luay Al Milah ◽  
...  
Keyword(s):  
Surgical Procedures ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Eras Protocol

The contribution of specific enhanced recovery after surgery (ERAS) protocol elements to reduced length of hospital stay after ventral hernia repair

2019 ◽  
Vol 34 (10) ◽  
pp. 4638-4644 ◽  
Author(s):  
Walker Ueland ◽  
Seth Walsh-Blackmore ◽  
Michael Nisiewicz ◽  
Daniel L. Davenport ◽  
Margaret A. Plymale ◽  
...  
Keyword(s):  
Hernia Repair ◽  
Hospital Stay ◽  
Ventral Hernia ◽  
Ventral Hernia Repair ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Length Of Hospital Stay ◽  
Eras Protocol

Systematic review and meta-analysis of the clinical utility of Enhanced Recovery After Surgery pathways in adult spine surgery

2020 ◽  
pp. 1-23
Author(s):  
Zach Pennington ◽  
Ethan Cottrill ◽  
Daniel Lubelski ◽  
Jeff Ehresman ◽  
Nicholas Theodore ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Spine Surgery ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Meta Analysis ◽  
Lumbar Spine Surgery ◽  
Complication Rates ◽  
Protocol Implementation ◽  
Eras Protocol ◽  
Adult Spine

OBJECTIVESpine surgery has been identified as a significant source of healthcare expenditures in the United States. Prolonged hospitalization has been cited as one source of increased spending, and there has been drive from providers and payors alike to decrease inpatient stays. One strategy currently being explored is the use of Enhanced Recovery After Surgery (ERAS) protocols. Here, the authors review the literature on adult spine ERAS protocols, focusing on clinical benefits and cost reductions. They also conducted a quantitative meta-analysis examining the following: 1) length of stay (LOS), 2) complication rate, 3) wound infection rate, 4) 30-day readmission rate, and 5) 30-day reoperation rate.METHODSUsing the PRISMA guidelines, a search of the PubMed/Medline, Web of Science, Cochrane Reviews, Embase, CINAHL, and OVID Medline databases was conducted to identify all full-text articles in the English-language literature describing ERAS protocol implementation for adult spine surgery. A quantitative meta-analysis using random-effects modeling was performed for the identified clinical outcomes using studies that directly compared ERAS protocols with conventional care.RESULTSOf 950 articles reviewed, 34 were included in the qualitative analysis and 20 were included in the quantitative analysis. The most common protocol types were general spine surgery protocols and protocols for lumbar spine surgery patients. The most frequently cited benefits of ERAS protocols were shorter LOS (n = 12), lower postoperative pain scores (n = 6), and decreased complication rates (n = 4). The meta-analysis demonstrated shorter LOS for the general spine surgery (mean difference −1.22 days [95% CI −1.98 to −0.47]) and lumbar spine ERAS protocols (−1.53 days [95% CI −2.89 to −0.16]). Neither general nor lumbar spine protocols led to a significant difference in complication rates. Insufficient data existed to perform a meta-analysis of the differences in costs or postoperative narcotic use.CONCLUSIONSPresent data suggest that ERAS protocol implementation may reduce hospitalization time among adult spine surgery patients and may lead to reductions in complication rates when applied to specific populations. To generate high-quality evidence capable of supporting practice guidelines, though, additional controlled trials are necessary to validate these early findings in larger populations.

scholarly journals P.233 Implementation of an Enhanced Recovery After Surgery (ERAS) Protocol for Scheduled Spine Surgery

2021 ◽  
Vol 48 (s3) ◽  
pp. S87-S88
Author(s):  
J Smith-Forrester ◽  
R Greene ◽  
S Christie
Keyword(s):  
Spine Surgery ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Current System ◽  
Length Of Hospital Stay ◽  
Care Program ◽  
Cost Of Care ◽  
Operative Care ◽  
Eras Protocol ◽  
Future Work

Background: Enhanced Recovery After Surgery (ERAS) Protocols improve post-surgical outcomes through decreased length of hospital stay, reduced readmission rates, decreased post-operative pain, and greater patient satisfaction. ERAS also has significant benefits to the healthcare system through reduced cost of post-operative care. While ERAS protocols are well established in many surgical fields, a complete guideline for spine surgery is lacking. Early ERAS studies in spine surgery suggest up to a 50% reduction in length of stay (LOS) and decreased cost of care. Methods: Primary literature review followed by multidisciplinary critical appraisal for optimization and redesign of our current system of care for scheduled spine surgery (SSS), including patient experience and team logistics from initial consultation through post-operative care and follow up. Results: An evidence-based guideline, optimizing pre-, intra-, and post-operative phases of care was developed. Specific focus catered to pre-operative education and patient barriers to discharge. Further improvements in pre-admission patient goal setting, introduction of a patient care “passport”, post-operative reduction in narcotic administration, and increased same day post-operative mobilization were means to reduce LOS. Conclusions: A spine ERAS pathway was developed, allowing our care program to better facilitate patient recovery after SSS. Future work will aim to determine economic impact of the pathway.

scholarly journals The successful implementation of the Enhanced Recovery After Surgery (ERAS) program among caesarean deliveries in Bhutan to reduce the postoperative length of hospital stay

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tshering Tamang ◽  
Tashi Wangchuk ◽  
Choning Zangmo ◽  
Tshering Wangmo ◽  
Karma Tshomo
Keyword(s):  
Hospital Stay ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Length Of Hospital Stay ◽  
Care Program ◽  
Postoperative Recovery ◽  
Successful Implementation ◽  
Hospital Data ◽  
Postoperative Length ◽  
Eras Protocol

Abstract Background Enhanced Recovery After Surgery (ERAS) is a multidisciplinary perioperative care program to optimize and enhance postoperative recovery. It has a beneficial role in decreasing the length of hospital stay and improving the quality of care. This study aims to observe the successful implementation of ERAS in reducing the length of hospital stay (LOS) among caesarean deliveries. Methods A pre-and post-implementation study of ERAS protocol was conducted, among cohort of women who underwent caesarean deliveries from January to December 2020 in the Department of Obstetrics and Gynaecology, Mongar Regional Referral hospital. Data collected retrospectively and analyzed in SPSS (IBM SPSS trial version); and comparison of length of hospital stay between the two groups were tested by t-test. Results One hundred seventy-one patients were included in the study: 87 in the pre-ERAS and 84 in the post-ERAS cohort. Post implementation, LOS decreased by an average of 21.0 (CI 16.11–24.64; p-value < 0.001) hours in the postoperative period. A greater proportion of patients were discharged on day-2 (2.3% in pre-ERAS and 81% in ERAS; p-value < 0.001). Conclusion Implementation of ERAS protocol can significantly decrease the postoperative length of hospital stay without increasing the complications and readmission rates.

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