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

Abstract

<h3>BACKGROUND CONTEXT</h3> Enhanced recovery after surgery (ERAS) is an evidence-based multidisciplinary perioperative protocol intended to reduce surgical morbidity and improve recovery. <h3>PURPOSE</h3> We sought to evaluate the impact of ERAS on in-hospital and 90-day postoperative opioid consumption, length of stay, urinary catheter removal and postoperative ambulation after lumbar fusion for degenerative conditions. <h3>STUDY DESIGN/SETTING</h3> Single center retrospective observational cohort study. <h3>PATIENT SAMPLE</h3> A total of 290 patients undergoing lumbar fusion surgery during the transition period prior to (N=174) and after (N=116) adoption of ERAS. <h3>OUTCOME MEASURES</h3> In-hospital and 90-day postop opioid consumption in morphine milligram equivalents (MME), pre- and postoperative pain scores, length of stay, urinary catheter removal and ambulation after surgery. <h3>METHODS</h3> We evaluated patients undergoing lumbar fusion surgery in the transition period prior to (N=174) and after (N=116) adoption of ERAS, comparing in-hospital and 90-day postop opioid consumption. Regression analysis was used to control for confounders. Secondary analysis was preformed to evaluate the association between ERAS and length of stay, urinary catheter removal and ambulation after surgery. <h3>RESULTS</h3> 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 better 3-month pain scores, ambulated earlier, had urinary catheters removed earlier and decreased in-hospital opioid consumption compared to Pre-ERAS patients. There was no difference in 90-day opioid consumption between the two groups. Regression analysis showed that ERAS was strongly associated with in-hospital opioid consumption, accounting for 30% of the variability in MME. In-hospital opioid consumption was also associated with preoperative pain scores, number of surgical levels, and insurance type (private vs government). Preoperative pain sores, but not ERAS were associated with 90-day opioid consumption. Secondary analysis showed that ERAS was associated with a shorter length of stay and earlier ambulation. <h3>CONCLUSIONS</h3> This study showed ERAS has the potential to improved recovery after lumbar fusion for degenerative conditions with reduced in-hospital opioid consumption and improved postoperative pain scores. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.