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Enhanced recovery in spinal surgery: proof of concept
EANS Academy. Kumaria A. 09/25/19; 275466; EP02026
Mr. Ashwin Kumaria
Mr. Ashwin Kumaria

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Abstract
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Enhanced recovery pathways following surgery confer multiple advantages including early mobilisation, decreased venous thromboembolism, decreased hospital acquired infections and obvious financial advantages. Despite widespread application in elective laparotomy, hip and knee arthroplasty, experience in spinal surgery is lacking. We evaluated the scope for enhanced recovery in spinal surgery.
We audited the three commonest spinal operations - microdiscectomy, decompression and instrumented decompression - and compared length of stay data between consultant spinal surgeons at our unit. We found significant variation in post-operative lengths of stay despite no difference in rate of complications. As variation provides opportunity for quality improvement, we made a case for enhanced recovery in elective lumbar spinal surgery. We hereby share our experience - pre-operative, peri-operative and post-operative.
Patient selection is key - motivated patients without serious comorbidities undergoing elective posterior lumbar spine surgery involving one or two levels are selected. Multidisciplinary 'prehab' sessions are led by physiotherapists to optimise muscle conditioning through core muscle strengthening and neural stretches. Patient education is supplemented through booklets and online/video resources.
On the day of surgery, unnecessarily long starvation and dehydration are avoided. Most cases only require a single dose of prophylactic antibiotic at induction. Small incisions are used and generous local anaesthetic is infiltrated to the wound. Intrathecal diamorphine is given for pain relief. Surgical and anaesthetic delays are avoided and short acting anaesthetic agents are used.
Post-operatively patients change into their own clothes at the earliest opportunity. Adequate pain relief is ensured. If urinary catheterisation is required, an 'in and out' strategy to empty the bladder is adopted. Patients are kept informed and therefore empowered at all times.
We anticipate an overall reduction in length of stay for elective spine surgery and increased patient satisfaction.
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