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Enhanced Perioperative Care for Major Spine Surgery.
Spine (Phila Pa 1976) 2019; 44(13):959-966S

Abstract

STUDY DESIGN

The enhanced perioperative care (EPOC) program is an institutional quality improvement initiative. We used a historically controlled study design to evaluate patients who underwent major spine surgery before and after the implementation of the EPOC program.

OBJECTIVE

To determine whether multidisciplinary EPOC program was associated with an improvement in clinical and financial outcomes for elective adult major spine surgery patients.

SUMMARY OF BACKGROUND DATA

The enhanced recovery after surgery (ERAS) programs successfully implemented in hip and knee replacement surgeries, and improved clinical outcomes and patient satisfaction.

METHODS

We compared 183 subjects in traditional care (TRDC) group to 267 intervention period (EPOC) in a single academic quaternary spine surgery referral center. One hundred eight subjects in no pathway (NOPW) care group was also examined to exclude if the observed changes between the EPOC and TRDC groups might be due to concurrent changes in practice or population over the same time period. Our primary outcome variables were hospital and intensive care unit lengths of stay and the secondary outcomes were postoperative complications, 30-day hospital readmission and cost.

RESULTS

In this highly complex patient population, we observed a reduction in mean hospital length of stay (HLOS) between TRDC versus EPOC groups (8.2 vs. 6.1 d, standard deviation [SD] = 6.3 vs. 3.6, P < 0.001) and intensive care unit length of stay (ILOS) (3.1 vs. 1.9 d, SD = 4.7 vs. 1.4, P = 0.01). The number (rate) of postoperative intensive care unit (ICU) admissions was higher for the TRDC n = 109 (60%) than the EPOC n = 129 (48%) (P = 0.02). There was no difference in postoperative complications and 30-day hospital readmissions. The EPOC spine program was associated with significant average cost reduction-$62,429 to $53,355 (P < 0.00).

CONCLUSION

The EPOC program has made a clinically relevant contribution to institutional efforts to improve patient outcomes and value. We observed a reduction in HLOS, ILOS, costs, and variability.

LEVEL OF EVIDENCE

3.

Authors+Show Affiliations

Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Washington. Department of Orthopaedic Surgery and Sports Medicine, Harborview Medical Center, University of Washington, Washington. Department of Neurological Surgery, Harborview Medical Center, University of Washington, Washington.Department of Orthopaedic Surgery and Sports Medicine, Harborview Medical Center, University of Washington, Washington. Department of Neurological Surgery, Harborview Medical Center, University of Washington, Washington.Department of Orthopaedic Surgery and Sports Medicine, Harborview Medical Center, University of Washington, Washington.Department of Orthopaedic Surgery and Sports Medicine, Harborview Medical Center, University of Washington, Washington. Department of Neurological Surgery, Harborview Medical Center, University of Washington, Washington.Department of Orthopaedic Surgery and Sports Medicine, Harborview Medical Center, University of Washington, Washington. Department of Neurological Surgery, Harborview Medical Center, University of Washington, Washington.Department of Orthopaedic Surgery and Sports Medicine, Harborview Medical Center, University of Washington, Washington. Department of Neurological Surgery, Harborview Medical Center, University of Washington, Washington. Department of Surgery, Harborview Medical Center, University of Washington, Washington.Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Washington.Department of Medicine, Harborview Medical Center, University of Washington, Washington.Department of Health Services, University of Washington, Washington.Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Washington. Department of Neurological Surgery, Harborview Medical Center, University of Washington, Washington.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31205177

Citation

Dagal, Armagan, et al. "Enhanced Perioperative Care for Major Spine Surgery." Spine, vol. 44, no. 13, 2019, pp. 959-966.
Dagal A, Bellabarba C, Bransford R, et al. Enhanced Perioperative Care for Major Spine Surgery. Spine. 2019;44(13):959-966.
Dagal, A., Bellabarba, C., Bransford, R., Zhang, F., Chesnut, R. M., O'Keefe, G. E., ... Souter, M. J. (2019). Enhanced Perioperative Care for Major Spine Surgery. Spine, 44(13), pp. 959-966. doi:10.1097/BRS.0000000000002968.
Dagal A, et al. Enhanced Perioperative Care for Major Spine Surgery. Spine. 2019 Jul 1;44(13):959-966. PubMed PMID: 31205177.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Enhanced Perioperative Care for Major Spine Surgery. AU - Dagal,Armagan, AU - Bellabarba,Carlo, AU - Bransford,Richard, AU - Zhang,Fangyi, AU - Chesnut,Randall M, AU - O'Keefe,Grant E, AU - Wright,David R, AU - Dellit,Timothy H, AU - Painter,Ian, AU - Souter,Michael J, PY - 2019/6/18/entrez PY - 2019/6/18/pubmed PY - 2019/8/21/medline SP - 959 EP - 966 JF - Spine JO - Spine VL - 44 IS - 13 N2 - STUDY DESIGN: The enhanced perioperative care (EPOC) program is an institutional quality improvement initiative. We used a historically controlled study design to evaluate patients who underwent major spine surgery before and after the implementation of the EPOC program. OBJECTIVE: To determine whether multidisciplinary EPOC program was associated with an improvement in clinical and financial outcomes for elective adult major spine surgery patients. SUMMARY OF BACKGROUND DATA: The enhanced recovery after surgery (ERAS) programs successfully implemented in hip and knee replacement surgeries, and improved clinical outcomes and patient satisfaction. METHODS: We compared 183 subjects in traditional care (TRDC) group to 267 intervention period (EPOC) in a single academic quaternary spine surgery referral center. One hundred eight subjects in no pathway (NOPW) care group was also examined to exclude if the observed changes between the EPOC and TRDC groups might be due to concurrent changes in practice or population over the same time period. Our primary outcome variables were hospital and intensive care unit lengths of stay and the secondary outcomes were postoperative complications, 30-day hospital readmission and cost. RESULTS: In this highly complex patient population, we observed a reduction in mean hospital length of stay (HLOS) between TRDC versus EPOC groups (8.2 vs. 6.1 d, standard deviation [SD] = 6.3 vs. 3.6, P < 0.001) and intensive care unit length of stay (ILOS) (3.1 vs. 1.9 d, SD = 4.7 vs. 1.4, P = 0.01). The number (rate) of postoperative intensive care unit (ICU) admissions was higher for the TRDC n = 109 (60%) than the EPOC n = 129 (48%) (P = 0.02). There was no difference in postoperative complications and 30-day hospital readmissions. The EPOC spine program was associated with significant average cost reduction-$62,429 to $53,355 (P < 0.00). CONCLUSION: The EPOC program has made a clinically relevant contribution to institutional efforts to improve patient outcomes and value. We observed a reduction in HLOS, ILOS, costs, and variability. LEVEL OF EVIDENCE: 3. SN - 1528-1159 UR - https://www.unboundmedicine.com/medline/citation/31205177/Enhanced_Perioperative_Care_for_Major_Spine_Surgery_ L2 - http://Insights.ovid.com/pubmed?pmid=31205177 DB - PRIME DP - Unbound Medicine ER -