P032: ENHANCED RECOVERY AFTER SURGERY IN EXTREME LATERAL LUMBAR INTERBODY FUSION SURGERY (XLIF): A RETROSPECTIVE ANALYSIS
Juan C Acosta, MD; Benjamin Cipion; Basma A Mohamed, MBChB; University of Florida
Introduction: The enhanced recovery after surgery (ERAS) protocol is a multimodal evidence-based approach to perioperative care to enhance recovery. The main goals of ERAS protocols are to improve overall surgical outcomes by reducing complications, decreasing the length of stay, and improving the patients' experience. For spine surgery patients, ERAS programs have focused on modifying surgical approaches to minimally invasive procedures, addressing pain management, and improving physiological functions. To date, there are no data on the impact of ERAS on outcomes in extreme lateral lumbar interbody fusion surgery (XLIF). Therefore, we aim to evaluate the impact of the ERAS pathway on postoperative outcomes in patients undergoing XLIF surgery at our institution.
Methods: The implementation of the ERAS pathway started in December 2018. This study is a retrospective analysis of consecutive patients who underwent XLIF for degenerative spine disease from July 2015-March 2022 who were compared to a historical cohort before ERAS implementation after obtaining IRB approval (IRB #202101716). Patient demographics, comorbidities, perioperative and clinical data were collected. The primary outcome was the length of hospital stay. Secondary outcomes included the first day of ambulation, complication rate, discharge disposition, and 30-day readmission rate. Postoperative pain scores and opioid consumption were also evaluated.
Results: Preliminary data analysis included 40 patients, 20 in the ERAS cohort, and 20 historical controls. Patients' demographics and comorbidities were similar between the groups. The ERAS group had a significantly improved length of hospital stay (4.25 vs. 3.3 days, p = 0.0487) without an increase in readmission rate. The ERAS cohort had an earlier first day of ambulation (p=0.0025), decreased opioid use on postoperative day 2 (p=0.0226), decrease in the use of patient-controlled analgesia (p=0.659) without an increase in the mean pain scores. The overall incidence of complications, including ICU admission, was not statistically significant between the groups (p=0.753). The rate of non-home discharge was lower in the ERAS group. However, this was not statistically significant (p=0.107).
Discussion: Our findings suggest that the implementation of ERAS was associated with an overall improved length of hospital stay and earlier ambulation in patients undergoing XLIF for degenerative spine disease without an increase in the 30-day readmission rate. Despite the decrease in other outcome measures, including complication rate, opioid consumption, and non-home discharge, these findings were not statistically significant. To date, no studies have evaluated the impact of ERAS in XLIF surgery. Despite the minimally invasive approach, the surgical population continues to be at high risk of experiencing postoperative pain and decreased mobility, both resulting from the chronicity of the degenerative spine disease. Both can result in a prolonged recovery. Our study has multiple limitations, including its retrospective design and small sample size, which may impact the generalizability.
Conclusion: ERAS protocol is a feasible approach for patients undergoing XLIF surgery for degenerative spine disease and has been shown to decrease the length of hospital stay and the time to first ambulation without an increase in readmission rate.