Implementation of enhanced recovery after surgery (ERAS) protocol for anterior cervical discectomy and fusion: a propensity score-matched analysis

• Published in: European spine journal Vol. 30; no. 2; pp. 560 - 567
• Main Authors: Debono, Bertrand, Sabatier, Pascal, Boniface, Guillaume, Bousquet, Philippe, Lescure, Jean-Paul, Garnaud, Valérie, Hamel, Olivier, Lonjon, Guillaume
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-02-2021; Springer Nature B.V
• Subjects: Demography; Diskectomy; Enhanced Recovery After Surgery; Female; Humans; Length of Stay; Male; Medicine; Medicine & Public Health; Morbidity; Neurosurgery; Original Article; Patients; Postoperative Complications - epidemiology; Propensity Score; Recovery (Medical); Retrospective Studies; Spine - surgery; Surgery; Surgical Orthopedics; Enhanced recovery after surgery; Propensity score; Fast track surgery; Anterior cervical discectomy and fusion
• ISSN: 0940-6719; 1432-0932
• DOI: 10.1007/s00586-020-06445-0

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.