The Evolution of ERAS: Assessing the Clinical Benefits of Developments within Enhanced Recovery After Surgery Protocols in Adult Cervical Deformity Surgery

Thursday, June 1, 2023

8:30 AM – 6:15 PM

Location: Salons 7-8

Co-Author(s)

PT

Peter S. Tretiakov, BS

United States
PD

Pooja R. Dave

Miami, Florida, United States
JM

Jamshaid M. Mir, MD

Research Fellow
NYU Langone Health | NY Spine Institute, United States
AC

Andrew Chen

United States
NV

Neel Vallurupalli

United States
TL

Tomi Lanre-Amos

United States
AF

Alexa Forman

United States
NP

Nicholas Post

United States
AM

Angel Macagno

United States
TR

Timothy Roberts

Orthopaedic Spine Surgeon
Westbury, New York, United States
AD

Alexandre De Moura

United States
AS

Andrew J. Schoenfeld, MD, MSc

Associate Professor
Brigham and Women's Hospital, Department of Orthopaedic Surgery
Boston, Massachusetts, United States

Presenting Author (Person doing the Podium Present(s)

PP

Peter G. Passias, M.D.

Spine Surgeon
NYU Langone Orthopedic Hospital
New York, New York, United States

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Submitter(s)

PP

Peter G. Passias, M.D.

Spine Surgeon
NYU Langone Orthopedic Hospital
New York, New York, United States

View E-Poster

Disclosure(s):

Peter G. Passias, MD: No relevant disclosure to display

Background: Enhanced Recovery After Surgery (ERAS) can help accelerate patient recovery and assist hospitals in maximizing the incentives of bundled payment models while maintaining high-quality patient care. However, such protocols are dynamic and evolving, and there remains a paucity of literature assessing how developments have impacted outcomes after adult cervical deformity (CD) surgery.

Purpose: To assess the impact of Enhanced Recovery After Surgery (ERAS) protocol evolution on peri-operative course after cervical deformity corrective surgery.

Methods: Operative CD patients ≥18yrs with complete pre-(BL) and up to 2-year(2Y) postop radiographic/HRQL data who underwent ERAS protocols were stratified by increasing implantation of ERAS component: Early (multimodal pain program), Intermediate (Early protocol + paraspinal blocks, early ambulation), and Late (Early/Intermediate protocols + comprehensive prehabilitation). Differences in demographics, clinical outcomes, radiographic alignment targets, peri-operative factors and complication rates were assessed via Bonferroni-adjusted means comparison analysis.

Results: 131 patients were included (59.4±11.7 years, 45% female, 28.8±6.0 kg/m2). Of these patients, 38.9% were considered Early, 36.6% were Intermediate, and 24.4% were Late. At baseline, groups were comparable by age, gender, BMI, and baseline Charlson Comorbidity Index scores (CCI) (all p>.05). In terms of BL disability, groups demonstrated incrementally increasing mJOA (p=.021) and EQ5D scores (p <.001). Peri-operatively, rates of durotomy were significantly lower in the Late group (p=.006) compared to the Early cohort, as were rates of intraoperative complications (p=.036). Post-operatively, discharge disposition differed significantly between cohorts, with Late patients more likely to be discharged to home versus Early or Intermediate cohorts (χ2(2)=37.973, p<.001). In terms of post-operative disability recovery, Intermediate and Late patients demonstrated incrementally improved 6W mJOA scores (p=.004), and Late patients maintained significantly higher mean EQ5D and mJOA scores by 1Y (p <.001, p=.026). By 2Y, cohorts demonstrated incrementally increasing SWAL-QOL Burden (p <.001), Eating Duration (p=.021), Food Selection (p=.018), Mental (p <.001), and Fatigue (p=.028) domain scores versus Early or Intermediate cohorts. By 2Y, incrementally decreasing reoperation were observed in Early vs Intermediate vs Late cohorts (p=.034).

Conclusions: Enhanced Recovery After Surgery (ERAS) protocols, as applied to adult cervical deformity surgery, have evolved over time in complexity and have begun to incorporate pre-operative optimization to reduce recovery burden and complication. The present study demonstrates that patients enrolled in an evolving ERAS programs demonstrate incremental improvement in pre-operative optimization and candidate selection, greater likelihood of discharge to home, decreased post-operative disability and dysphasia burden, and decreased likelihood of intra-operative complications and reoperation rates.