General Session: Endoscopic Surgery
Presented by: K. Madhavan
K. Madhavan(1), H.-K. Chang(2), J.P. Kolcun(1), T. Urakov(1), J. Grossman(3), M.Y. Wang(1)
(1) University of Miami Miller School of Medicine, Neurosurgery, Miami, FL, United States
(2) School of Medicine, National Yang-Ming University, Taipei, Taiwan, Neurosurgery, Taipei, Taiwan, Republic of China
(3) University of Miami Miller School of Medicine, Anesthesiology, Miami, FL, United States
Introduction: The concept of enhance recovery after surgery (ERAS®) is relatively new to neurosurgical field. The introduction of ERAS® protocol in lumbar fusion surgery aimed to accelerate patient recovery, reduce stress from surgery and decrease narcotic consumption.
Method: Patients with 1 or 2-level degenerative lumbar spine disease underwent transforaminal lumbar interbody fusion (TLIF) with ERAS® protocol were retrospectively reviewed and compared to standard minimally invasive (MIS) TLIF. ERAS patients had awake fusion with endoscopic assisistance, expandable cage with depoform bupivacaine injection. The conventional MIS-TLIF were performed under general anesthesia and TLIF was performed using Taylor retractor.
Result: The first 50 ERAS® TLIF were compared to a series of 50 patients received standard MIS-TLIF (MIS group) by the same surgeon during the same time period. The operation time and blood loss significantly favored ERAS® TLIF, although not statistically significant. The average daily narcotic consumption was remarkably lower in the ERAS group than the MIS group on POD 0 and 1 (p< 0.001). Average narcotic dosage throughout entire in-hospital period was also significantly reduced in the ERAS group compared to the MIS group for the first 2 days The average length of hospital stay was substantially shorter in the ERAS group. (1.4±1.13 vs 4.0±1.98 days, p< 0.001*).
Conclusion: The present study demonstrated a significant decline in the consumption of narcotic medication and length of hospital stay for patients undergoing ERAS® TLIF for 1 or 2-level degenerative lumbar spine disease. Although, small cohort, we believe that ERAS protocols will enable improved outcomes in spine surgery and less narcotic dependence.