Implementation of an Enhanced Recovery Pathway in Complex Spine Surgery Patients in a Multidisciplinary Center

Abstract

Abstract INTRODUCTION The implementation of an Enhanced Recovery After Surgery (ERAS) pathway involves a multidisciplinary approach to multimodal perioperative care in order to achieve improved outcome measures. ERAS pathways apply evidence-based practice to surgical care resulting in increased value for both the patient and institution with a marked decrease in length of stay and other measureable complications. Variations in ERAS pathways have been applied other surgical specialties but the application in complex spine surgery has been limited due to the heterogeneity of the patients and procedures. Our ERAS program differs from other spine ERAS programs in that we focused on the most challenging patient population in which accounts for a great deal of morbidity associated with complex spine surgery. METHODS An initial meeting involving all key stakeholders mapped the spine surgery patient experience and identified potential gaps in patient care. An interdisciplinary team approach was established with clinician champions identified within each clinical specialty to encompass the full spectrum of needs for complex spine patients. Guidelines for best practices in perioperative spine care were reviewed, resulting in the establishment of a tightly managed process and timeline. The ERAS program was successfully implemented for complex spine patients on August 1, 2018. RESULTS To date, there has been a marked decrease in Mean ICU days from 1.92 to 1.64 d. The length of stay as decreased from 6.47 d in our complex spine population to 5.73 d. The mean opioid consumption has drastically decreased from 610.80 (OME) in pre-ERAS patients to 297.90 (OME) in post-ERAS patients. CONCLUSION Our results thus far demonstrate the feasibility of integrating a comprehensive ERAS program into multidisciplinary spine care. Initial results demonstrate significant opportunities to improve the value to complex spine patients with modest additional expenditures.