Implementation of enhanced recovery after surgery (ERAS) protocol for anterior cervical discectomy and fusion: a propensity score-matched analysis
Purpose Enhanced recovery after surgery (ERAS), still emerging for the spine, proposes a multimodal approach of perioperative care involving the optimization of every procedural step, with the patient in a proactive position regarding his/her management. We aimed to demonstrate a reduction in the le...
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| Published in: | European spine journal Vol. 30; no. 2; pp. 560 - 567 |
|---|---|
| Main Authors: | , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Berlin/Heidelberg
Springer Berlin Heidelberg
01-02-2021
Springer Nature B.V |
| Subjects: | |
| Online Access: | Get full text |
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| Summary: | Purpose
Enhanced recovery after surgery (ERAS), still emerging for the spine, proposes a multimodal approach of perioperative care involving the optimization of every procedural step, with the patient in a proactive position regarding his/her management. We aimed to demonstrate a reduction in the length of hospital stay for ACDF without increasing the risk for patients by comparing 2 groups before and after ERAS implementation using propensity score (PS)-matched analysis.
Methods
We selected 2 periods of 1 year, before (
n
= 268 patients) and after ERAS implementation (
n
= 271 patients). Data were collected on patient demographics, operative and perioperative details, 90-day readmissions and morbidity. ERAS-trained nurses were involved to support patients at each pre/per/postoperative step with the help of a mobile app. A satisfaction survey was included. PS analyses were used for dealing with confounding bias in this retrospective observational study.
Results
After PS matching, the outcomes of 202 well-balanced pairs of patients were compared (conventional vs ERAS). LOS was reduced from 2.96 ± 1.35 to 1.40 ± 0.6 days (Student,
p
< 0.001). All 90-day surgical morbidity was similar between the 2 groups, including 30-day readmission (0.5% vs 0%;
p
= 1), 30- to 90-day readmission (0.5% vs 0.0%;
p
= 1), 90-day reoperation (0% vs 1%;
p
= 0.49), major complications (3.0% vs 3.5%;
p
= 1) and minor complications (2.0% vs 3.5%;
p
= 0.54). There was no significant difference concerning the satisfaction survey.
Conclusions
The introduction of ERAS for ACDF in our institution has resulted in a significant decrease in LOS, without causing an increase in postoperative complications and has maintained patients’ satisfaction. |
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| Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3 |
| ISSN: | 0940-6719 1432-0932 |
| DOI: | 10.1007/s00586-020-06445-0 |