Blog Post

How a perioperative surgical protocol improves outcomes for spine patients

June 6, 2018

    First pioneered for patients undergoing colorectal surgery in 2010, the Enhanced Recovery after Surgery (ERAS) patient protocol is now gaining traction across a variety of different procedures, including surgical spine. That's because this patient-centered, evidence-based medicine protocol has proven effective in lowering complication rates, reducing length of stay, and minimizing costs for hospitals.

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    Planners are talking about ERAS because of its potential implications on margins and patient satisfaction. Here's what you need to know about ERAS coming to spine, considerations for implementation, and where ERAS might go in the future.

    What is ERAS?

    Early results from the ERAS model have caused a buzz in the medical community. In several large reviews of the protocol, total costs, readmission rates, length of stay, and the rate of perioperative complications decreased dramatically. John's Hopkins, for instance, found that implanting ERAS for colorectal surgery lowered costs by $1,500 per patient.

    In contrast with the typical surgical care pathway—which often lacks a formalized set of pre-surgical and post-surgical consultations—ERAS emphasizes holistic and interdisciplinary pre- and post-surgical care. Prior to the surgery, patients receive education and set dietary goals; during surgery, physicians use evidence-based surgical guidelines to perform the procedure; and after surgery, patients receive pain management, nutrition assistance, and physiotherapy.  

    How is ERAS being used in spine surgeries?

    Last month, at the 2018 American Association of Neurological Surgeons' (AANS) annual meeting, a group of researchers from the University of Pennsylvania revealed new evidence proving the benefit of ERAS in elective spine and nerve surgery. Their study showed spine surgery patients who followed the protocol had both superior surgical outcomes and, notably, less reliance on opioids for pain management after the surgery. As organizations hone in on reducing opioid usage, the ERAS protocol offers a promising approach.

    What's unique about the ERAS protocol is its flexibility—as providers discover the impact of different surgical factors, the protocol evolves. Staff at Cleveland Clinic's Spine Center, for example, found that 15% of all spine patients had severe anemia before undergoing surgery, which was worsening patient outcomes. In response, they built in a new protocol: patients must receive a blood test at least six weeks before surgery to allow ample time to treat patients who may have anemia.

    Where could ERAS go in the future?

    Looking ahead, it's likely that neurosurgery will be the next expanded use for the ERAS protocol given the demand to improve functional recovery and reduce length of stay for these complex patients. Several studies have called upon hospitals to begin designing and implementing ERAS protocols for patients undergoing craniotomies because there is limited existing literature on evidence-based protocols that can address the inherent morbidity and mortality associated with the surgery.

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