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Implementation of enhanced recovery after surgery (ERAS) protocol for anterior cervical discectomy and fusion: a propensity score-matched analysis

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Abstract

Purpose

Enhanced recovery after surgery (ERAS), still emerging for the spine, proposes a multimodal approach of perioperative care involving the optimization of every procedural step, with the patient in a proactive position regarding his/her management. We aimed to demonstrate a reduction in the length of hospital stay for ACDF without increasing the risk for patients by comparing 2 groups before and after ERAS implementation using propensity score (PS)-matched analysis.

Methods

We selected 2 periods of 1 year, before (n = 268 patients) and after ERAS implementation (n = 271 patients). Data were collected on patient demographics, operative and perioperative details, 90-day readmissions and morbidity. ERAS-trained nurses were involved to support patients at each pre/per/postoperative step with the help of a mobile app. A satisfaction survey was included. PS analyses were used for dealing with confounding bias in this retrospective observational study.

Results

After PS matching, the outcomes of 202 well-balanced pairs of patients were compared (conventional vs ERAS). LOS was reduced from 2.96 ± 1.35 to 1.40 ± 0.6 days (Student, p < 0.001). All 90-day surgical morbidity was similar between the 2 groups, including 30-day readmission (0.5% vs 0%; p = 1), 30- to 90-day readmission (0.5% vs 0.0%; p = 1), 90-day reoperation (0% vs 1%; p = 0.49), major complications (3.0% vs 3.5%; p = 1) and minor complications (2.0% vs 3.5%; p = 0.54). There was no significant difference concerning the satisfaction survey.

Conclusions

The introduction of ERAS for ACDF in our institution has resulted in a significant decrease in LOS, without causing an increase in postoperative complications and has maintained patients’ satisfaction.

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Acknowledgements

The authors are grateful to Antoine Guillain for his collaboration with the preparation of the manuscript and for the organization of the phone survey.

Funding

No funds were received in support of this work.

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Authors and Affiliations

  1. Department of Neurosurgery, Neuroscience Pole, Ramsay-Clinique des Cèdres, 31700, Cornebarrieu, France

    Bertrand Debono, Pascal Sabatier, Guillaume Boniface, Philippe Bousquet, Jean-Paul Lescure & Olivier Hamel

  2. Medical Information Department, Ramsay-Clinique des Cèdres, Cornebarrieu, France

    Valérie Garnaud

  3. Department of Orthopedic Surgery-Orthosud, Clinique st jean.Groupement SANTECITE., Montpellier, France

    Guillaume Lonjon

Authors
  1. Bertrand Debono
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  2. Pascal Sabatier
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Correspondence to Bertrand Debono.

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Debono, B., Sabatier, P., Boniface, G. et al. Implementation of enhanced recovery after surgery (ERAS) protocol for anterior cervical discectomy and fusion: a propensity score-matched analysis. Eur Spine J 30, 560–567 (2021). https://doi.org/10.1007/s00586-020-06445-0

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