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. 2022 Feb 4:14:100120.
doi: 10.1016/j.wnsx.2022.100120. eCollection 2022 Apr.

Enhanced Recovery After Surgery Protocol in Minimally Invasive Lumbar Fusion Surgery Reduces Length of Hospital Stay and Inpatient Narcotic Use

Isabelle C Band  1 , Altan O Yenicay  2 , Tina D Montemurno  2 , Jenny S Chan  2 , Alfred T Ogden  3   4
Affiliations

Enhanced Recovery After Surgery Protocol in Minimally Invasive Lumbar Fusion Surgery Reduces Length of Hospital Stay and Inpatient Narcotic Use

Isabelle C Band et al. World Neurosurg X. .

Abstract

Background: The application of enhanced recovery after surgery (ERAS) has the potential to improve outcomes, hasten patient recovery, and reduce costs. ERAS has been applied to spine surgery for several years, but data are limited around the impact of ERAS on minimally invasive spine surgery, specifically. The authors report their experience implementing a multimodal ERAS protocol for patients receiving minimally invasive transforaminal lumbar interbody fusion.

Methods: The ERAS protocol was implemented at The Valley Hospital Hospital in Ridgewood, New Jersey in January 2020. Following implementation, all patients receiving minimally invasive transforaminal lumbar interbody fusion by a single surgeon were studied. The authors analyze the impact of the protocol on length of stay (LOS), disposition post discharge, and opioid consumption postoperatively in the inpatient and outpatient settings.

Results: Sixteen patients were enrolled in the protocol and compared with 17 historical controls. LOS was significantly shorter in the ERAS cohort (1.6 vs. 2.4 days, P = 0.022). There was no significant difference between the groups with respect to disposition; the majority of patients were discharged to home without need for in-home medical services. Patients in the ERAS cohort consumed significantly fewer opioid analgesics postoperatively in the inpatient setting (51 mg morphine milligram equivalents vs. 320 mg morphine milligram equivalents, P = 0.00016). On average, patients in the ERAS cohort were prescribed fewer opioids analgesics post discharge.

Conclusions: ERAS application to minimally invasive transforaminal lumbar interbody fusion was safe and effective, significantly reducing LOS and inpatient opioid consumption. These data reflect the importance of uniformly applying a multimodal ERAS protocol to accelerate recovery and reduce narcotic use.

Keywords: ERAS, Enhanced recovery after surgery; Enhanced recovery after surgery; Fast-track surgery; LOS, Length of stay; MIS-TLIF, Minimally invasive−transforaminal lumbar fusion; MME, Morphine milligram equivalents; Minimally invasive surgery; Spine surgery.

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Figures

Figure 1
Figure 1
Enhanced recovery after surgery protocol for minimally invasive−transforaminal lumbar fusion at The Valley Hospital.
Figure 2
Figure 2
Length of stay for enhanced recovery after surgery and control patients.
Figure 3
Figure 3
Disposition of enhanced recovery after surgery and control patients post discharge.
Figure 4
Figure 4
Mean total postoperative opioid consumption by enhanced recovery after surgery and control cohorts in the inpatient setting.
Figure 5
Figure 5
Amount of opioids prescribed in first postoperative prescription for the outpatient setting.
Figure 6
Figure 6
Amount of opioids prescribed in first postoperative prescription plus subsequent refills for the outpatient setting.
See this image and copyright information in PMC

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