311. Assessment of the effect of implementation of enhanced recovery after surgery program in spinal surgical procedures: a retrospective study

Abstract

BACKGROUND CONTEXT Enhanced Recovery after Surgery (ERAS) protocols are multimodal and multidisciplinary perioperative care strategies, and have been demonstrated to be associated with facilitated functional recovery process, improved patient experience and outcomes, as well as reduced cost and length of hospital stay (LOS). Even with increasing evidences of success in many major surgical procedures, there is limited data related to ERAS programs on the spine surgery. In addition, implementation of new practices is difficult, and has been suggested that change in clinical practice occurs 15 yrs after clear evidence is available. PURPOSE In this retrospective analysis, we tested the hypothesis that implementation of ERAS protocol would contribute to decrease LOS after spinal fusion procedures. STUDY DESIGN/SETTING Quality Improvement Retrospective Study. PATIENT SAMPLE Refer to Methods. OUTCOME MEASURES Refer to Methods. METHODS The medical, surgical and anesthesia records of 1,399 patients aged ≥80 yr and ASA 1-3 undergoing spinal fusion procedures based on Medicare Severity Diagnosis Related Groups (MSDRG) (S460) during the years of 2015, 2016 and 2017 in our institution were reviewed. Study patients were assigned into one of three study groups based on experience of implementation of ERAS: Group 1 (Year-2015) was standard postoperative management with multimodal pain management, Group 2 (Year-2016) was standard postoperative management + initial implementation of Progression of Care Rounds (POCR) (Year I) program (multidisciplinary team members continuously provided patient care by addressing key points for each patient and taking necessary steps to improve the patient recovery process) and Group 3 (Year-2017) was standard postoperative management + POCR (Year II). The demographic characteristics, recovery profiles, opioid dosages, side effects and LOS were recorded. Data were analyzed using the Student's t-test, chi-square test or the Fisher exact test, with p-values RESULTS The 3 study groups were similar with respect to their demographic characteristics. However, the LOS was significantly reduced in patients who received more experience of POCR (Year II) management (Year-2017) when compared to either standard postoperative management (Year-2015) or initial POCR (Year I) management (Year-2016). Not surprisingly, the average direct cost per case was also decreased 8% when patient received more experience of POCR management. CONCLUSIONS In this retrospective review study, more experience of ERAS programs (PORC) improved patient recovery process, and decreased the LOS along with cost-savings in patients after spinal fusion procedures (MSDRG S460). Future studies are needed to design and implement more detail ERAS protocols, and evaluate their efficacy through prospective randomized, double-blinded and controlled clinical trials. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.