Background
Enhanced recovery after surgery (ERAS) protocols address pre-, peri-, and postoperative factors of a patient’s surgical journey. ERAS engages all healthcare providers in a longitudinal fashion, with an underlying theme of reduction of the dramatic stress response due to surgery.The authors sought to assess the effects of a novel ERAS protocol on clinical outcomes for patients undergoing elective spine or peripheral nerve surgery.
Intervention and Design
This is a prospective cohort analysis to evaluate the impact of a novel ERAS protocol for patients undergo- ing elective spine or peripheral nerve surgery by the same attending neurosurgeons who operate at a single hospital (Pennsylvania Hospital) within the University of Pennsylvania Health System. The 2 cohorts underwent treatment at a single institution before ERAS implementation (September–December 2016) and after ERAS implementation (April–June 2017).
Intervention - The authors conducted a prospective cohort analysis comparing clinical outcomes of patients undergoing elective spine or peripheral nerve surgery after implementation of the ERAS protocol compared to a historical control cohort in a tertiary care academic medical center. Patients in the historical cohort (September–December 2016) underwent traditional surgical care. Patients in the intervention group (April–June 2017) were enrolled in a unique ERAS protocol created by the Department of Neurosurgery at the University of Pennsylvania.
Main Outcomes and Measures - Primary objectives were as follows: opioid and non-opioid pain medication consumption, need for opioid use at 1 month postoperatively, and patient-reported pain scores. Secondary objectives were as follows: mobilization and ambulation status, Foley catheter use, need for straight catheterization, length of stay, need for ICU admission, discharge status, and readmission within 30 days.
Way to Health Use
- Study Enrollment: Enroll and randomize participants in the study
- Discharge Date Finder: Collect data from EPIC regarding patient’s discharge date
- Text Message Reminders: Text reminders sent throughout the intervention
Findings and Conclusions
The 2 groups were similar in baseline demographics. Intravenous opioid medications postoperatively via patient-controlled analgesia was nearly eliminated in the ERAS group (0.5% vs 54.1%, p < 0.001). This change was not associated with an increase in the average or daily pain scores in the ERAS group. At 1 month following surgery, a smaller proportion of patients in the ERAS group were using opioids (38.8% vs 52.7%, p = 0.041). The ERAS group demonstrated greater mobilization on postoperative day 0 (53.4% vs 17.1%, p < 0.001) and postoperative day 1 (84.1% vs 45.7%, p < 0.001) compared to the control group. Postoperative Foley use was decreased in the ERAS group (20.4% vs 47.3%, p < 0.001) without an increase in the rate of straight catheterization (8.1% vs 11.9%, p = 0.51).
Implementation of this novel ERAS pathway safely reduces patients’ postoperative opioid requirements during hospitalization and 1 month postoperatively. ERAS results in improved postoperative mobilization and ambulation.