Enhanced Recovery After Spinal Surgery: A Multimodal Approach to Patient Care

Abstract

cantly since the turn of the century. Between 1998 and 2008, the annual number of spinal fusion discharges increased 137%, a higher rate than other common inpatient procedures such as laminectomy and hip arthroplasty. Moreover, the average age of patients undergoing spine surgery is increasing. In the Medicare population, rates of complex fusions in particular are increasing at a staggering rate. The growing number of surgical procedures and rising patient age are also associated with increases in morbidity and mortality, which contribute to longer length of stay (LOS) and rising costs. Furthermore, spine procedures have a high incidence of severe pain, especially on the first postoperative day, and lumbar fusions have been rated in the top 6 of most painful surgical procedures. Most commonly, opioid medications are used to manage postoperative and chronic pain for spine patients. However, opioid-related deaths skyrocketed from 0.4% in 2001 to 1.5% in 2016, representing a 292% increase. Thus, the ever-growing national concern regarding opioid usage poses a challenge to spine surgeons attempting to provide the most appropriate pharmacotherapy to manage their patients’ pain. A solution for this constellation of current challenges will likely not arise solely from new surgical technologies or techniques, but rather in an approach that improves upon all aspects of patient care. Spine surgeons should begin examining the patient experience as a whole to identify methods of decreasing pain and shortening hospital stays, thus improving outcomes for all patients. One notable approach that has gained international momentum during the last several decades is Enhanced Recovery After Surgery (ERAS), and applications within spine surgery seem promising.