Benefits of Enhanced Recovery After Surgery for fusion in degenerative spine surgery: impact on outcome, length of stay, and patient satisfaction

Autor: Olivier Hamel, Marco Vincenzo Corniola, Pascal Sabatier, Raphael Pietton, Bertrand Debono, Enrico Tessitore
Rok vydání: 2019
Předmět:
Adult
Male
Postoperative Complications/epidemiology
medicine.medical_specialty
Lumbar Vertebrae/surgery
medicine.medical_treatment
Anterior cervical discectomy and fusion
Intervertebral Disc Degeneration
Spinal Fusion/methods
Patient Readmission
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Patient satisfaction
Lumbar
Patient experience
medicine
Humans
030212 general & internal medicine
Enhanced recovery after surgery
Retrospective Studies
Intervertebral Disc Degeneration/surgery
Lumbar Vertebrae
business.industry
General Medicine
Perioperative
Length of Stay
Middle Aged
Mobile Applications
Patient Discharge
ddc:616.8
Surgery
Institutional repository
Spinal Fusion
Treatment Outcome
Patient Satisfaction
Spinal fusion
Female
Neurology (clinical)
Enhanced Recovery After Surgery
business
030217 neurology & neurosurgery
Diskectomy
Zdroj: Neurosurgical Focus, Vol. 46, No 4 (2019) P. E6
ISSN: 1092-0684
DOI: 10.3171/2019.1.focus18669
Popis: OBJECTIVEEnhanced Recovery After Surgery (ERAS) proposes a multimodal, evidence-based approach to perioperative care. Thanks to the improvement in care protocols and the fluidity of the patient pathway, the first goal of ERAS is the improvement of surgical outcomes and patient experience, with a final impact on a reduction in the hospital length of stay (LOS). The implementation of ERAS in spinal surgery is in the early stages. The authors report on their initial experience in applying an ERAS program to several degenerative spinal fusion procedures.METHODSThe authors selected two 2-year periods: the first from before any implementation of ERAS principles (pre-ERAS years 2012–2013) and the second corresponding to a period when the paradigm was applied widely (post-ERAS years 2016–2017). Patient groups in these periods were retrospectively compared according to three degenerative conditions requiring fusion: anterior cervical discectomy and fusion (ACDF), anterior lumbar interbody fusion (ALIF), and posterior lumbar fusion. Data were collected on patient demographics, operative and perioperative data, LOSs, 90-day readmissions, and morbidity. ERAS-trained nurses were involved to support patients at each pre-, intra-, and postoperative step with the help of a mobile application (app). A satisfaction survey was included in the app.RESULTSThe pre-ERAS group included 1563 patients (159 ALIF, 749 ACDF, and 655 posterior fusion), and the post-ERAS group included 1920 patients (202 ALIF, 612 ACDF, and 1106 posterior fusion). The mean LOS was significantly shorter in the post-ERAS group than in the pre-ERAS group for all three conditions. It was reduced from 6.06 ± 1.1 to 3.33 ± 0.8 days for the ALIF group (p < 0.001), from 3.08 ± 0.9 to 1.3 ± 0.7 days for the ACDF group (p < 0.001), and from 6.7 ± 4.8 to 4.8 ± 2.3 days for posterior fusion cases (p < 0.001). There was no significant difference in overall complications between the two periods for the ALIF (11.9% pre-ERAS vs 11.4% post-ERAS, p = 0.86) and ACDF (6.0% vs 8.2%, p = 0.12) cases, but they decreased significantly for lumbar fusions (14.8% vs 10.9%, p = 0.02). Regarding satisfaction with overall care among 808 available responses, 699 patients (86.5%) were satisfied or very satisfied, and regarding appreciation of the mobile e-health app in the perceived optimization of care management, 665 patients (82.3%) were satisfied or very satisfied.CONCLUSIONSThe introduction of the ERAS approach at the authors’ institution for spinal fusion for three studied conditions resulted in a significant decrease in LOS without causing increased postoperative complications. Patient satisfaction with overall management, upstream organization of hospitalization, and the use of e-health was high. According to the study results, which are consistent with those in other studies, the whole concept of ERAS (primarily reducing complications and pain, and then reducing LOS) seems applicable to spinal surgery.
Databáze: OpenAIRE
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