The Effects of ERAS Protocol on Complex Spine Surgery Complications and Length of Stay: a Single Institution Study
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Background: With the goal of improving patient outcomes, the Integrated Spine Center at UT Southwestern Medical Center implemented an Enhanced Recovery After Surgery (ERAS) protocol which includes pre and post surgery guidelines. The goal of this study was to investigate the impact of the ERAS protocol on complication rates in the perioperative period, as well as length of stay in hospital and ICU.
Materials and Methods: A retrospective cohort study was performed on all patients (3,495) who underwent spine surgery between September 2016 and September 2021. Of those, 2,472 met inclusion criteria as complex spine cases, and were divided into non-ERAS (2,147) and ERAS (325) groups. Patients in each group were matched for gender, age range, BMI range, comorbidities, and surgery type. Post-operative complications such as surgical site infection, acute kidney injury, deep vein thrombosis, myocardial infarction, sepsis, pneumonia, pulmonary embolism, stroke, shock, and other complications were recorded, as was length of stay. A two-tailed Fisher's exact test was used to establish significance.
Results: Significant differences between the ERAS and non-ERAS groups were found in complication rates of UTI (7.3% vs. 1.4%, respectively; P=0.011), and any complications (30% vs. 19.6%, respectively; P=0.032). Length of stay was also significantly different between the ERAS and non-ERAS groups (5.4 ± 3.4 vs. 4.7 ± 3.7 d, respectively; P=0.018). There was no significant difference in the rates of other complications, or in length of ICU stay.
Conclusions: Implementation of the ERAS protocol did not decrease complication rates or length of stay, and ERAS patients had significantly higher rates of UTI or any complications, as well as average length of stay. There may have been confounding factors due to the type of cases where ERAS was followed.
Key Words: perioperative protocol, complex spine surgery, complication rates, length of sta