P068: MPLEMENTATION OF AN ENHANCED RECOVERY AFTER SURGERY (ERAS) PROGRAM FOR PATIENTS UNDERGOING SAME DAY OUTPATIENT ELECTIVE MINIMALLY INVASIVE TRANSFORAMINAL LUMBAR INTERBODY FUSION (MIS TLIF).
Uhuru Smith, MD; Samuel Joseph, MD; Advanced Surgery Center of Tampa
Presentation style: Prospective
Topic area: Outpatient spinal surgery
Keywords: General anesthesia, intrathecal anesthesia, lumbar spine surgery, outpatient, pain, transforaminal lumbar interbody fusion, minimally invasive spine surgery, multi-modal anesthesia, ERAS
Introduction: Enhanced Recovery After Surgery (ERAS) programs for improving spinal fusion surgery are possible and necessary. To date no programs have been described for minimally invasive transforaminal lumbar interbody fusion (MIS TLIF), to allow same day discharge in a safe and effective manner. In this report the authors review the development of a true outpatient approach to MIS TLIF.
Methods: The first 39 consecutive patients in which the ERAS program was implemented for elective one and two level MIS TLIF with bilateral pedicle screw instrumentation were reviewed. A synergistic protocol including preoperative medication, intrathecal anesthesia combined with general and local anesthesia, and postoperative medication was implemented. Data collection was performed by review of medical records. Number of levels fused, age, operative time, time to discharge, readmission rate, after hours call to office, wound complications, postoperative narcotic use till first postoperative visit and rates of postoperative urinary retention were recorded.
Summary of Results: 26 one level, two level MIS TLIFs performed, mean age was 48 years (Range 48 - 64), mean operative time 109 minutes (Range 57 – 227), mean time to discharge was 162 minutes (Range 79 – 338), there was no premature refill of narcotic, no readmission, no calls to office or premature return to office related to pain, no postoperative urinary retention, no wound complications.
Conclusion: This report describes the first ERAS protocol for MIS TLIF. Pre-, intra- and postoperative interventions resulted in effective same day discharge with no reported complications and no readmissions.