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Adoption of enhanced surgical recovery (ESR) protocol for adult spinal deformity (ASD) surgery decreases in-hospital and 90-day post-operative opioid consumption

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Abstract

Purpose

Retrospective observational cohort study of primary adult spinal deformity (ASD) surgery during the transitional period prior to and after the implementation of Enhanced Surgical Recovery (ESR) at a single center. We sought to determine if ESR reduces in-hospital and 90-day post-operative opioid consumption for ASD surgery.

Methods

We evaluated patients undergoing primary ASD surgery in the transition period prior to (N = 29) and after (N = 56) adoption of ESR, comparing in-hospital and 90-day post-operative opioid consumption. Regression analysis was used to control for confounders including age, number of surgical levels, surgical approach, staged vs same-day surgery, insurance type and pre-op opioid use.

Results

Mean age of the cohort was 53 years with 57 (60%) females. Regression analysis showed that pre-operative opioid use and number of levels fused were associated with higher in-hospital and 90-day post-operative opioid consumption, while use of ESR was associated with lower in-hospital and 90-day post-operative opioid consumption. Secondary analysis showed that patients on ESR ambulated earlier (0.6 days vs 1.1, p = 0.028) and had their urinary catheter removed earlier (2.7 days vs 3.9, p = 0.006) compared to non-ESR patients.

Conclusions

ESR was associated with a significantly decreased in-hospital and 90-day post-operative opioid consumption and earlier mobilization with earlier urinary catheter removal in patients undergoing primary ASD surgery. These results demonstrate ESR’s potential to improve outcomes in ASD perioperative care.

Level of evidence

3.

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Availability of data and material

Data available upon request.

Code availability

Not applicable.

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Funding

No outside funds were received for this study.

Author information

Authors and Affiliations

  1. Virginia Spine Institute, 11800 Sunrise Valley Drive, Suite 800, Reston, VA, 20191, USA

    Ehsan Jazini, Alexandra E. Thomson, Andre D. Sabet, Lindsay Orosz, Fenil R. Bhatt, Colin M. Haines, Thomas C. Schuler & Christopher R. Good

  2. National Spine Health Foundation, Reston, VA, USA

    Omar Sohail, Lindsay Orosz & Rita Roy

  3. Norton Leatherman Spine Center, Louisville, KA, USA

    Leah Y. Carreon

Authors
  1. Ehsan Jazini
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  2. Alexandra E. Thomson
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  3. Andre D. Sabet
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  4. Omar Sohail
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  5. Leah Y. Carreon
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  6. Lindsay Orosz
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  7. Fenil R. Bhatt
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  8. Rita Roy
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  9. Colin M. Haines
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  10. Thomas C. Schuler
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  11. Christopher R. Good
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Contributions

EJ, AET, ADS, OS, LYC, LO, FRB, RR, CMH, TCS, CRG: made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work; EJ, AET, ADS, OS, LYC, LO, FRB, RR, CMH, TCS, CRG: drafted the work or revised it critically for important intellectual content; EJ, AET, ADS, OS, LYC, LO, FRB, RR, CMH, TCS, CRG: approved the version to be published; and EJ, AET, ADS, OS, LYC, LO, FRB, RR, CMH, TCS, CRG: agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Alexandra E. Thomson.

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Conflicts of interest/Competing interests

CRG has received consulting fees from K2M, Stryker, Medtronic, Mazor and is on an advisory board for Stryker, Augmedics, Medtronic, has received royalties from K2M and has stock in Augmedics and NSite. LYC is an employee of Norton Healthcare and the University of Southern Denmark; received consulting fees from the National Spine Health Foundation; member, Editorial Advisory Board, Spine Deformity, The Spine Journal and Spine; member University of Louisville IRB; institution received research funds from OREF, NIH, ISSG, SRS, TSRH, Pfizer, Lifesciences Corporation, IntelliRod, Cerapedics, Medtronic, Empirical Spine and NeuroPoint Alliance. EJ has received consulting fees from Medtronic, Stryker, and Precision Spine. CMH has received consulting fees from Medtronic, Globus Medical, and Spineart. The authors have no other conflicts of interest to declare.

Ethics approval

Quorum Review serves as a central IRB and approved the study protocol (File #: 33866/1) on February 3rd, 2019. Migration of IRB from Quorum to Advarra occurred September 4th, 2019, with the study approval for ERAS-001 (Pro00036529). This study was conducted in accordance with the 1964 Helsinki Declaration, its amendments, and other equivalent ethical standards.

Consent to participate

All study participants or their legally authorized representative signed written informed consent for study participation prior to surgery, included in the Notice of Privacy Practices.

Consent for publication

All study participants or their legally authorized representative signed written informed consent for publication prior to surgery, included in the Notice of Privacy Practices.

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Jazini, E., Thomson, A.E., Sabet, A.D. et al. Adoption of enhanced surgical recovery (ESR) protocol for adult spinal deformity (ASD) surgery decreases in-hospital and 90-day post-operative opioid consumption. Spine Deform 10, 443–448 (2022). https://doi.org/10.1007/s43390-021-00437-w

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  • DOI: https://doi.org/10.1007/s43390-021-00437-w

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