Impact of Enhanced Recovery After Surgery (ERAS) Protocols in Adult Spinal Deformity Corrective Surgery Utilizing Three Column Osteotomies

Introduction: Spine surgery for ASD is often highly invasive, especially when requiring three column osteotomies, that can often coincide with a prolonged recovery phase. These patients might benefit from ERAS, an evidence-based multidisciplinary approach to perioperative management that aims to decrease complications and readmissions while improving functional recovery.

Methods: ASD patients who had 3CO, with complete baseline(BL) and perioperative(Peri-Op) data were included. Multivariable logistic regression and ANCOVA assessed differences in outcomes while accounting for age, CCI, frailty, baseline deformity, and invasiveness.

Results: 67 ASD patients with 3CO were included. Stratification of 3CO based on receiving ERAS (E3) and not (NE3) resulted in 30 in E3 and 37 in NE3. EBL was significantly higher in NE3 (2854 vs 848mL, p<.001), which translated to higher rates of blood transfusion (63% vs 33%, p=.035). No difference in operative time (567min). Discharge to home was higher in E3 (19.2% vs 10%, p=.3). SICU rates were lower in E3 (32% vs 68%, p=.008). Preoperative and postoperative opioid MME was significantly higher in NE3 (Pre: 64.5 vs 15.9, p=.001, Post: 118.9 vs 100.9, p=.003). Rates of opioid usage remained lower through two year follow up (SRS-22q11), with no difference in back pain (NRS-Back). Ambulation distance prior to discharge was significantly higher in E3 (134 vs 49ft, p=.011). Complication rates leading to readmissions were lower in E3 (4% vs 11%, p=.36), with reoperation rates higher in NE3 (11% vs 0%, p=.095). SRS-22R was significantly lower in E3 until 1 Year follow up (p <.05).

Conclusion : Enhanced recovery after surgery protocol in adult spinal deformity corrective surgery utilizing three-column osteotomy has shown to improve earlier recovery and return to function while requiring less opioid usage during the postoperative period.