Multi-Institutional Enhanced Recovery After Surgery (ERAS) Protocol in Cervical Spine Surgery: A Michigan Spine Surgery Improvement Collaborative (MSSIC) Study
Anisse N. Chaker, MD: No financial relationships to disclose
Introduction: The utilization of enhanced recovery after surgery (ERAS) protocols have been validated in various surgical specialties, with the intention to facilitate decreased post-operative complication rates and length of stay, while improving patient satisfaction. There is a paucity of literature analyzing the effects of an ERAS protocol for spine surgery in a multi-institutional setting. We aim to study patient outcomes (PROs) following the implementation of a statewide multi-institutional ERAS protocol in cervical spine surgery.
Methods: The Michigan Spine Surgery Improvement Collaborative (MSSIC) database was queried for patients across 29 hospitals undergoing cervical spine surgery from January 2017 to December 2019 and when the ERAS protocol was implemented from January 2022 to July 2023. Multivariate analysis was conducted to compare outcomes of patients in this cohort who underwent the standardized ERAS protocol with those who did not. Outcomes measured include adverse events, timing and disposition of discharge, readmissions, and patient reported outcomes.
Results: 2,208 patients were included in the analysis with 1,821 patients undergoing the ERAS protocol and 387 who did not. Patients who underwent the ERAS protocol were more likely to be discharged home (RR = 1.06; CI: 1.03-1.09, p < 0.001), and were less likely to have an extended length of stay (≥ 3 days) or be readmitted (RR = 0.40; CI: 0.28-0.58, p < 0.001 and RR = 0.64, CI: 0.42-0.99, p = 0.043, respectively). Patients were also less likely to endure a post-operative complication (RR = 0.58, CI: 0.40-0.82, p = 0.003).
Conclusion : The implementation of a statewide ERAS protocol for elective cervical spine surgery demonstrates a potential benefit in patient clinical outcomes and cost-saving measures.