Local adaptation of Enhanced Recovery after Surgery (ERAS) in Open Transforaminal Lumbar Interbody Fusion (TLIF) can improve efficiency safely

This abstract has open access
Abstract Description
Submission ID :
HAC37
Submission Type
Authors (including presenting author) :
WAN Raymond Chung Wai; WONG, Yu Chung; LAW, Sheung Wai; KWOK, Kin On
Affiliation :
1: Department of Orthopaedics & Traumatology, Prince of Wales Hospital

2: Department of Orthopaedics & Traumatology, Chinese University of Hong Kong
Introduction :
Open TLIF (transforaminal lumbar interbody fusion) remains the workhorse for lumbar spine degeneration patients, with massive demand and caseload. With limited resources yet growing demand, improving in its efficiency will benefit overall patient care as a whole.



Enhanced Recovery after Surgery (ERAS) is a multidisciplinary approach that uses a combination of evidence-based methods to improve patient-care outcomes. It composes of various measures pre-operation, intraoperative and post-operation. There are various similar but different guidelines worldwide. With different setting in different countries/region, local adaptation will be needed for realistic wide-spread use. This paper is to review outcomes of a Hong Kong public tertiary centre practicing ERAS in open TLIF surgery.
Objectives :
To review the results of ERAS in Open TLIF versus historical cohort of non-ERAS patient
Methodology :
This is a retrospective review of 48 consecutive months of all primary, open, Transforaminal Lumbar Interbody Fusion (TLIF) surgery of one or two levels. They are segregated into ERAS and non-ERAS group based on treatment received. The data was retrieved from electronic and paper record. The operation time was based on anaesthetists record and blood loss was based on accurate intraoperative estimate, including weighing blood soaked gauze and measuring suction bottle. The parameters studied included the length of stay, blood loss, hemoglobulin drop and transfusion rate, complication rate, and review on related factors including obesity, malnutrition and smoking rate.
Result & Outcome :
There were 15 patients in ERAS and 23 patients in non-ERAS group. There was no difference in demographics including age (ERAS age 67.0 years vs Non-ERAS 70.9 years, p>0.05), gender, Body mass index (BMI), smoker, alcoholics and malnutrition, number of surgery levels. Mean time to follow up was ERAS 442.5 days vs non-ERAS 534.0 days (p>0.05).



ERAS group shows lower blood loss (564.3 ml vs 1008.5ml, p=0.026), lower hemoglobulin drop (1.60g/dL vs 2.39 g/dL, p=0.037), earlier return to full diet (1.53 days vs 2.61 days, p=0.048). There were trend to shorter total acute and rehabilitation hospital stay (median ERAS 12.0 vs Non-ERAS 20.0 days, p>0.05). In post-hoc analysis, if one ERAS extreme outlier is removed, ERAS group present with mean total length of stay 4.7 days shorter. [ 16.93 days vs 21.65 days Non ERAS. (p=.036)]
Prince Of Wales Hospital, Orthopaedics And Traumatology
17 visits