Hospital for Special Surgery, Spine Service, 535 East 70th St., New York, NY 10021, USA.
Hospital for Special Surgery, Spine Service, 535 East 70th St., New York, NY 10021, USA.
Spine J. 2021 May;21(5):753-764. doi: 10.1016/j.spinee.2021.01.003. Epub 2021 Jan 9.
Enhanced recovery (ERAS) pathways can help hospitals maximize the incentives of bundled payment models while maintaining high-quality patient care. A key component of an enhanced recovery pathway is the ability to predictably reduce inpatient length of stay, as this is a critical component of the cost equation.
To determine the efficacy of an enhanced recovery pathway on reducing length of stay after thoracolumbar adult deformity surgery.
Single surgeon retrospective review of prospectively-collected data.
Forty adult deformity patients who underwent ≥5 levels of fusion to the pelvis (two to L5) with a single surgeon before and after implementation of an ERAS pathway.
The pathway involved participation by anesthesiology, hospital medicine, and physical therapy, and was designed to achieve goals previously associated with decreased LOS (eg, EBL<1200 mL, procedure time <4.5 hours, avoidance of ICU postoperatively, and mobilization POD0-1). Patients were propensity-score matched 1:1 to a historical cohort (enhanced recovery [ER] and historical [H] cohorts), based on demographics, medical comorbidities, radiographic alignment parameters, and surgical factors. Outcomes were compared to determine the effect of the enhanced recovery pathway. Primary outcomes included LOS and 90-day complications and readmissions.
After matching, gender, BMI, ASA class, preoperative opioid dependence, day of surgery, sagittal alignment parameters, rate of revision surgery, three-column osteotomies, and interbody fusions were comparable between the cohorts (p>.05). In the ER cohort, there was reduced EBL (920±640 vs. 1437±555, p=.004) and no ER patient went to the ICU immediately following surgery, compared with 30% of H patients (p=.022). The ER cohort also had a greater number of patients ambulating by POD1 compared to the H cohort (100% vs. 55%, p=.010). ER patients had a shorter LOS (4.5±1.3 vs. 7.3±4.4 days, p=.010). A 90-day readmission and complications were comparable between the cohorts (p>.05).
The creation of an ERAS pathway for patients undergoing thoracolumbar adult deformity surgery reduced length of stay without negatively affecting short-term morbidity and complications. Given the specificity of this pathway to a single surgeon and hospital, the resources and staffing changes that were instrumental in creating the pathway may not be generalizable to other centers.
强化康复（ERAS）路径可以帮助医院在保持高质量患者护理的同时最大限度地利用捆绑支付模式的激励措施。ERAS 路径的一个关键组成部分是能够可预测地缩短住院时间，因为这是成本方程的一个关键组成部分。
确定强化康复路径在减少胸腰椎成人畸形手术后住院时间方面的效果。
前瞻性收集数据的单外科医生回顾性研究。
在实施 ERAS 路径前后，由一位外科医生为 40 名接受≥5 级融合至骨盆（从 2 级到 L5 级）的成人畸形患者进行治疗。
该途径涉及麻醉科、医院医学和物理治疗的参与，旨在实现与降低 LOS 相关的目标（例如，EBL<1200mL、手术时间<4.5 小时、术后避免 ICU 和 POD0-1 下地活动）。患者根据人口统计学、合并症、影像学对准参数和手术因素进行 1:1 倾向评分匹配，分为增强恢复（ER）和历史（H）队列。比较结果以确定强化康复途径的效果。主要结果包括 LOS 和 90 天并发症和再入院。
匹配后，两组在性别、BMI、ASA 分级、术前阿片类药物依赖、手术日、矢状面对准参数、翻修手术率、三柱截骨术和椎间融合术方面无差异（p>.05）。在 ER 组中，与 H 组相比，EBL 减少（920±640 与 1437±555，p=.004），且无 ER 患者在手术后立即入住 ICU，而 H 组中有 30%的患者入住 ICU（p=.022）。与 H 组相比，ER 组有更多的患者在 POD1 下地活动（100%比 55%，p=.010）。ER 患者的 LOS 更短（4.5±1.3 与 7.3±4.4 天，p=.010）。两组 90 天再入院率和并发症无差异（p>.05）。
为接受胸腰椎成人畸形手术的患者创建 ERAS 路径可缩短住院时间，而不会对短期发病率和并发症产生负面影响。鉴于该途径的特异性，创建该途径所需的资源和人员配备变化可能无法推广到其他中心。
