The Impact of Peri-operative Enhanced Recovery After Surgery Protocols on Outcomes Following Adult Cervical Deformity Surgery.

Abstract

Study DesignRetrospective cohort study.ObjectivesTo assess the impact of Enhanced recovery after surgery (ERAS) protocols on peri-operative course in adult cervical deformity (ACD) corrective surgery.MethodsPatients ≥18 yrs with complete pre-(BL) and up to 2-year (2Y) radiographic and clinical outcome data were stratified by enrollment in an ERAS protocol that commenced in 2020. Differences in demographics, clinical outcomes, radiographic alignment targets, peri-operative factors and complication rates were assessed via means comparison analysis. Logistic regression analysed differences while controlling for baseline disability and deformity.ResultsWe included 220 patients (average age 58.1 ± 11.9 years, 48% female). 20% were treated using the ERAS protocol (ERAS+). Disability was similar between both groups at baseline. When controlling for baseline disability and myelopathy, ERAS- patients were more likely to utilize opioids than ERAS+ (OR 1.79, 95% CI: 1.45-2.50, <i>P</i> = .016). Peri-operatively, ERAS+ had significantly lower operative time (<i>P</i> < .021), lower EBL (583.48 vs 246.51, <i>P</i> < .001), and required significantly lower doses of propofol intra-operatively than ERAS- patients (<i>P</i> = .020). ERAS+ patients also reported lower mean LOS overall (4.33 vs 5.84, <i>P</i> = .393), and were more likely to be discharged directly to home (χ2(1) = 4.974, <i>P</i> = .028). ERAS+ patients were less likely to require steroids after surgery (<i>P</i> = .045), were less likely to develop neuromuscular complications overall (<i>P</i> = .025), and less likely experience venous complications or be diagnosed with venous disease post-operatively (<i>P</i> = .025).ConclusionsEnhanced recovery after surgery programs in ACD surgery demonstrate significant benefit in terms of peri-operative outcomes for patients.