Enhanced Recovery After Surgery Reduces Postoperative Opioid Use and 90-Day Readmission Rates After Open Thoracolumbar Fusion for Adult Degenerative Deformity

• Published in: Neurosurgery Vol. 88; no. 2; pp. 295 - 300
• Main Authors: Adeyemo, Emmanuel A, Aoun, Salah G, Barrie, Umaru, Nguyen, Madelina L, Badejo, Olatunde, Pernik, Mark N, Christian, Zachary, Dosselman, Luke J, El Ahmadieh, Tarek Y, Hall, Kristen, Reyes, Valery Peinado, McDonagh, David L, Bagley, Carlos A
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01.02.2021; Copyright by the Congress of Neurological Surgeons; Wolters Kluwer Health, Inc
• Subjects: Adult; Aged; Analgesics, Opioid - therapeutic use; Complications and side effects; Constipation; Enhanced Recovery After Surgery; Female; Humans; Male; Medical research; Medicine, Experimental; Middle Aged; Narcotics; Patient Readmission - statistics & numerical data; Postoperative Complications - epidemiology; Postoperative Complications - prevention & control; Recovery (Medical); Retrospective Studies; Scoliosis; Scoliosis - surgery; Spinal Fusion - adverse effects; Spinal Fusion - methods; Surgery; Tranexamic acid; Texas; Adult degenerative deformity; Deformity surgery; Spine outcomes; Enhanced recovery after surgery; Adult degenerative scoliosis; Opioid use; Postoperative outcomes; ERAS
• ISSN: 0148-396X; 1524-4040; 1524-4040
• DOI: 10.1093/neuros/nyaa399

Abstract 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. Graphical Abstract Graphical Abstract