Evaluation of enhanced recovery after spine surgery: specificities in an academic public hospital.

Abstract

INTRODUCTION\nEnhanced Recovery After Surgery (ERAS) has been well described in many surgical specialties, including orthopedics. Application in spine surgery, on the other hand, is more recent and not yet precisely assessed. The present study aimed to assess the implementation of an ERAS program in a European spine surgery department and its impact on length of hospital stay and complications rate.\n\n\nMATERIALS AND METHODS\nA comparative observational study was conducted on patient progression with and without ERAS. As of the launch date of the program, all eligible patients were included over a 6 month period. A retrospective control group comprised patients managed over the same 6 month period of the previous year, matched for pathology, comorbidity and individual surgeon. Endpoints comprised mean length of stay and major complications (i.e., requiring readmission or revision surgery within 90 days).\n\n\nRESULTS\nEighty-eight patients were included: 44 per group. Demographic characteristics did not significantly differ between groups. Mean length of stay, taking all pathologies together, was 3.3 days in ERAS versus 6 days in the control group (p<0.001). Complications rates did not significantly differ between groups (p=1).\n\n\nDISCUSSION\nThe introduction of the ERAS program gave care teams the opportunity to think over good practices and set up a number of concomitant measures generally agreed to be effective in isolation. The present study showed ERAS to be perfectly feasible in a public-sector structure, reducing length of stay without increasing the rate of complications.\n\n\nLEVEL OF EVIDENCE\nIV CEBM.