139. Adoption of enhanced recovery after surgery (ERAS) protocol for lumbar fusion decreases in-hospital postoperative opioid consumption

Abstract

BACKGROUND CONTEXT ERAS is a multimodal and multidisciplinary evidence-based perioperative approach for surgery intended to reduce surgical morbidity and improve recovery. PURPOSE We sought to evaluate the impact of ERAS implementation on in-hospital and 90-day postop opioid consumption, length of stay, urinary catheter removal and postop ambulation after lumbar fusion for degenerative conditions STUDY DESIGN/SETTING Prospective observational cohort study. PATIENT SAMPLE Patients undergoing lumbar fusion for degenerative spine conditions in the transition period prior to (N=29) and after (N=56) adoption of ERAS. OUTCOME MEASURES In-hospital and 90-day postop opioid consumption measured in morphine milligram equivalents (MMEs), postop day mobilization and urinary catheter removal. METHODS From a multisurgeon, single center, we evaluated patients undergoing lumbar fusion surgery in the transition period prior to (N=63) and after (N=70) adoption of ERAS, comparing in-hospital and 90-day postop opioid consumption. Regression analysis was used to control for confounders including age, number of surgical levels, surgical approach, revision, staged vs same-day surgery, insurance type and preop opioid use. Secondary analysis evaluating the association of ERAS and length of stay, urinary catheter removal and ambulation after surgery was also performed. RESULTS Mean age of the cohort was 52.6 years with 62 (47%) females. Demographic characteristics were similar between the pre-ERAS and ERAS groups. ERAS patients had a shorter operative time, less blood loss, shorter length of stay, ambulated earlier and had less in-hospital opioid consumption compared to pre-ERAS patients. There was no difference in day of urinary catheter removal or 90-day opioid consumption between the two groups. Regression analysis showed that ERAS was strongly associated with in-hospital opioid consumption, accounting for 26% of the variability in MMEs consumed in-hospital. Other factors associated with in-hospital opioid consumption was age and operative time. Age and revision surgery, but not ERAS was associated with 90-day opioid consumption. Secondary analysis showed that ERAS was associated with a shorter length of stay and earlier ambulation but not early urinary catheter removal after surgery. CONCLUSIONS ERAS was associated with decreased in-hospital postop opioid consumption, shorter length of stay and earlier ambulation but not 90-day postop opioid consumption or early urinary catheter removal after lumbar fusion for degenerative conditions. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.