Patient outcomes following implementation of an enhanced recovery after surgery pathway for patients with metastatic spine tumors

Cancer. 2022 Dec 1;128(23):4109-4118. doi: 10.1002/cncr.34484. Epub 2022 Oct 11.

Abstract

Background: Metastatic spine tumor surgery consists of palliative operations performed on frail patients with multiple medical comorbidities. Enhanced recovery after surgery (ERAS) programs involve an evidence-based, multidisciplinary approach to improve perioperative outcomes. This study presents clinical outcomes of a metastatic spine tumor ERAS pathway implemented at a tertiary cancer center.

Methods: The metastatic spine tumor ERAS program launched in April 2019, and data from January 2018 to May 2020 were reviewed. Measured outcomes included the following: hospital length of stay (LOS), time to ambulation, urinary catheter duration, time to resumption of diet, intraoperative fluid intake, estimated blood loss (EBL), and intraoperative and postoperative day 0-5 cumulative opioid use (morphine milligram equivalent [MME]).

Results: A total of 390 patients were included in the final analysis: 177 consecutive patients undergoing metastatic spine tumor surgery enrolled in the ERAS program and 213 consecutive pre-ERAS patients. Although the mean case durations were similar in the ERAS and pre-ERAS cohorts (265 vs. 274 min; p = .22), the ERAS cohort had decreased EBL (157 vs. 215 ml; p = .003), decreased postoperative day 0-5 cumulative mean opioid use (178 vs. 396 MME; p < .0001), earlier ambulation (mean, 34 vs. 57 h; p = .0001), earlier discontinuation of urinary catheters (mean, 36 vs. 56 h; p < .001), and shorter LOS (5.4 vs. 7.5 days; p < .0001).

Conclusions: The implementation of a multidisciplinary ERAS program designed for metastatic spine tumor surgery led to improved clinical quality metrics, including shorter hospitalizations and significant reductions in opioid consumption.

Keywords: ERAS; Spine; Stereotactic Body Radiation Therapy; metastases; metastatic epidural spinal cord compression; opioid; separation surgery.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Analgesics, Opioid
  • Enhanced Recovery After Surgery*
  • Humans
  • Length of Stay
  • Postoperative Complications
  • Retrospective Studies
  • Spine

Substances

  • Analgesics, Opioid
  • MME