Enhanced Recovery After Surgery (ERAS) Reduces Length of Stay and Postoperative Opioid Use in Elective Peripheral Nerve Surgery Patients
Disha S Joshi, BS1, Svetlana Kvint, MD1, Marie Kerr, CCRP1, Rachel Pessoa, MSN, CRNP1, Michael Kallan, MS1, Eric L Zager, MD2 and Zarina S Ali, MD, MS1, (1)University of Pennsylvania, Philadelphia, PA, (2)Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA
Introduction: Enhanced Recovery After Surgery (ERAS) protocols have recently emerged as patient-care pathways to improve surgical outcomes and reduce length of stay. A novel ERAS protocol has been put into place for all patients undergoing elective spine and peripheral nerve surgery at a single academic institution since April 2017. The authors sought to assess the efficacy of their neurosurgical ERAS protocol in patients undergoing common peripheral nerve procedures.
Methods: Patients who underwent elective peripheral nerve surgery at a single academic institution between April 2017 and December 2018 were prospectively enrolled in a unique ERAS protocol. The control group was a historical cohort of patients who underwent elective peripheral nerve surgery at either the same hospital or a sister institution between September 2016 and December 2016. Surgeries included upper and lower extremity nerve decompression/transfer, nerve biopsy, peripheral nerve tumor resection, and brachial plexus surgery. The primary outcomes were length of stay and discharge disposition. The secondary outcomes included pain score at discharge and self-reported opioid use at one month after surgery.
Results: A total of 50 peripheral nerve surgery patients were enrolled into the ERAS protocol. The historical control group comprised 15 peripheral nerve surgery patients. The two groups were similar in baseline demographics and surgical type (p=0.07). In compliance with the ERAS protocol, the use of a PCA postoperatively was completely eliminated (ERAS 0.0% vs. control 46.7%, p<0.001) and that of IV narcotics was significantly reduced (ERAS 30.0% vs. control 73.3%, p=0.006). The ERAS group demonstrated decreased length of stay in the hospital compared to the control group (1.3 vs. 2.3 days; p=0.018). Although most patients in both groups were discharged home (ERAS 96.0% vs. control 93.4%), 0.0% of the ERAS patients, compared to 47.6% of the control patients, needed to be discharged with health services. Interestingly, the average pain score reported at discharge was lower for the ERAS group compared to the control group (2.1 vs. 6.0, p<0.001). Lastly, a smaller proportion of the ERAS group reported opioid use at one month postoperatively compared to the control group (ERAS 31.7% vs. control 73.3%, p=0.007).
Conclusion: This study suggests that implementation of the ERAS protocol in the peripheral nerve surgery population facilitates expeditious discharge out of the hospital, without the need for postoperative health services, and reduces opiate use at one month postoperatively.
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