The application of an enhanced recovery after spine surgery to lumbar instrumentation

AIM Enhanced recovery after surgery(ERAS) is a set of multidisciplinary evidence-based strategies to prepare patients for surgery and to accelerate the recovery process postoperatively while improving surgical outcomes. Despite success in several subspecialties, enhanced recovery after spine surgery(ERSS) has yet to be established. We hypothesized that such a program would have a significant influence on clinical and economic outcomes in spine instrumentation. MATERIAL AND METHODS This study describedthe introduction of the ERSSprogram, and we compared 86 consecutive patients who participated in ERSS with a retrospective cohort of 88 patients who underwent the same surgery before the implementation of thisprogram. Groups were compared in terms of age, sex, body mass index (BMI), American Society of Anesthesiologist (ASA) physical scores, operative time, comorbidities, intraoperative blood loss, blood transfusion rate, first oral intake, time of first mobilization, length of hospital stay, preoperative and postoperative pain scores using anumeric pain rating scale,30-day readmission andcomplication rates, and total cost. RESULTS Groups were similar in terms of age, sex, BMI, ASA scores, and comorbidities. Intraoperative blood loss, blood transfusion rate, and length of hospital stay were lower in the ERSS group. First oral intake and first mobilization occurred earlier in the ERSS group. Postoperative pain scores were significantly lower in the ERSS group. Operative time, readmissions, or complications at 30 days did not statistically differ between the two groups. The ERSS group was foundto besignificantly cost effective. CONCLUSION ERSS is feasible, comprehensive, and cost effective for spine instrumentation with better perioperative outcomes.