TY - JOUR
T1 - Enhanced Recovery after Surgery Reduces Postoperative Opioid Use and 90-Day Readmission Rates after Open Thoracolumbar Fusion for Adult Degenerative Deformity
AU - Adeyemo, Emmanuel A.
AU - Aoun, Salah G.
AU - Barrie, Umaru
AU - Nguyen, Madelina L.
AU - Badejo, Olatunde
AU - Pernik, Mark N.
AU - Christian, Zachary
AU - Dosselman, Luke J.
AU - El Ahmadieh, Tarek Y.
AU - Hall, Kristen
AU - Reyes, Valery Peinado
AU - McDonagh, David L.
AU - Bagley, Carlos A.
N1 - Publisher Copyright:
Copyright © 2020 by the Congress of Neurological Surgeons.
PY - 2021/2/1
Y1 - 2021/2/1
N2 - BACKGROUND: The role of enhanced recovery after surgery (ERAS) pathways implementation has not been previously explored in adult deformity patients. OBJECTIVE: To determine the impact of ERAS pathways implementation in adult patients undergoing open thoraco-lumbar-pelvic fusion for degenerative scoliosis on postoperative outcome, opioid consumption, and unplanned readmission rates. METHODS: In this retrospective single-center study, we included 124 consecutive patients who underwent open thoraco-lumbar-pelvic fusion from October 2016 to February 2019 for degenerative scoliosis. Primary outcomes consisted of postoperative supplementary opioid consumption in morphine equivalent dose (MED), postoperative complications, and readmission rates within the postoperative 90-d window. RESULTS: There were 67 patients in the ERAS group, and 57 patients served as pre-ERAS controls. Average patient age was 69 yr. The groups had comparable demographic and intraoperative variables. ERAS patients had a significantly lower rate of postoperative supplemental opioid consumption (248.05 vs 314.05 MED, P =. 04), a lower rate of urinary retention requiring catheterization (5.97% vs 19.3%, P =. 024) and of severe constipation (1.49% vs 31.57%, P <. 0001), and fewer readmissions after their surgery (2.98% vs 28.07%, P =. 0001). CONCLUSION: A comprehensive multidisciplinary approach to complex spine surgery can reduce opioid intake, postoperative urinary retention and severe constipation, and unplanned 90-d readmissions in the elderly adult population.
AB - BACKGROUND: The role of enhanced recovery after surgery (ERAS) pathways implementation has not been previously explored in adult deformity patients. OBJECTIVE: To determine the impact of ERAS pathways implementation in adult patients undergoing open thoraco-lumbar-pelvic fusion for degenerative scoliosis on postoperative outcome, opioid consumption, and unplanned readmission rates. METHODS: In this retrospective single-center study, we included 124 consecutive patients who underwent open thoraco-lumbar-pelvic fusion from October 2016 to February 2019 for degenerative scoliosis. Primary outcomes consisted of postoperative supplementary opioid consumption in morphine equivalent dose (MED), postoperative complications, and readmission rates within the postoperative 90-d window. RESULTS: There were 67 patients in the ERAS group, and 57 patients served as pre-ERAS controls. Average patient age was 69 yr. The groups had comparable demographic and intraoperative variables. ERAS patients had a significantly lower rate of postoperative supplemental opioid consumption (248.05 vs 314.05 MED, P =. 04), a lower rate of urinary retention requiring catheterization (5.97% vs 19.3%, P =. 024) and of severe constipation (1.49% vs 31.57%, P <. 0001), and fewer readmissions after their surgery (2.98% vs 28.07%, P =. 0001). CONCLUSION: A comprehensive multidisciplinary approach to complex spine surgery can reduce opioid intake, postoperative urinary retention and severe constipation, and unplanned 90-d readmissions in the elderly adult population.
KW - Adult degenerative deformity
KW - Adult degenerative scoliosis
KW - Deformity surgery
KW - ERAS
KW - Enhanced recovery after surgery
KW - Opioid use
KW - Postoperative outcomes
KW - Spine outcomes
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U2 - 10.1093/neuros/nyaa399
DO - 10.1093/neuros/nyaa399
M3 - Article
C2 - 32893863
AN - SCOPUS:85098979289
SN - 0148-396X
VL - 88
SP - 295
EP - 300
JO - Neurosurgery
JF - Neurosurgery
IS - 2
ER -