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Journal of Neurosurgical Sciences 2016 Apr 14


lingua: Inglese

A perspective on the use of an Enhanced Recovery Programme in open, non-instrumented, ‘day-surgery’ for degenerative lumbar and cervical spinal conditions

Hari K. VENKATA 1, James R. VAN DELLEN 2

1 Department of Anaesthetics, Queen Elizabeth Hospital, Birmingham, UK; 2 Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, UK


BACKGROUND: A means of significantly shortening patients’ length of hospital stay, improving their outcome and thereby also reducing costs is to use an Enhanced Recovery Programme (ERP) which is increasingly being used in a number of surgical sub-specialties. This paper provides a perspective on its prospective use in a wide-ranging, unselected cohort of patients undergoing open spinal surgery for degenerative lumbar and cervical spinal conditions. Selected spinal cases undergoing ‘day surgery’ have been increasingly reported.
METHODS: A prospective, unselected, consecutive cohort of 246 cases, over an 18 month period, undergoing open, non-instrumented decompression spinal surgery and using ERP (and the concept of ‘bundles of care’) was analyzed.
RESULTS: Nine cases could not be included as they did not fully meet the entry criteria. No routine follow-up was arranged for the study group. The ages ranged widely, from 23-90 years (mean 57). In 187 the surgery for ‘degenerative’ conditions was lumbar and in 50 cervical. The ASA (American Association of Anaesthesiologists) ratings were 108=1; 107=2 and 22=3. Using the United Kingdom (UK) National Health Service (NHS) definitions of length of stay 225 (95%) could be finally classified as ‘ambulatory’ and 12 (5%) were ‘short stay’. A sub-cohort of 126 (53.2%) were ‘day cases’. The follow-up was >1year for all. There were no wound infections reported; 5 post-discharge cases (2.1%) needed to be seen in the Accident and Emergency (A & E) Department (less than 4 days post-surgery), but none needed re-admission; and there were 7 re-admissions (2.5%), between 4 and 30 days, and of these 6 required a further surgical procedure. There were no long-term instability complications reported in this cohort.
CONCLUSIONS: ERP can be used for spinal surgery. There were identifiable and correctable medical and social factors found on analysis which could significantly increase the ‘day cases’’ number to over 90%.

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