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

Access to this content is reserved for EANS members and attendees of this event. Click here to become an EANS member and gain your access to the full content of the EANS Academy

Discussion Forum (0)
Rate & Comment (0)
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.
Code of conduct/disclaimer available in General Terms & Conditions
Anonymous User Privacy Preferences

Strictly Necessary Cookies (Always Active)

MULTILEARNING platforms and tools hereinafter referred as “MLG SOFTWARE” are provided to you as pure educational platforms/services requiring cookies to operate. In the case of the MLG SOFTWARE, cookies are essential for the Platform to function properly for the provision of education. If these cookies are disabled, a large subset of the functionality provided by the Platform will either be unavailable or cease to work as expected. The MLG SOFTWARE do not capture non-essential activities such as menu items and listings you click on or pages viewed.

Performance Cookies

Performance cookies are used to analyse how visitors use a website in order to provide a better user experience.

Google Analytics is used for user behavior tracking/reporting. Google Analytics works in parallel and independently from MLG’s features. Google Analytics relies on cookies and these cookies can be used by Google to track users across different platforms/services.

Save Settings