Enhanced Perioperative Care for Major Spine Surgery.

Area of Science:

• Quality Improvement Initiatives
• Multidisciplinary Care Models
• Spine Surgery Outcomes

Background:

• Enhanced recovery after surgery (ERAS) programs have demonstrated success in orthopedic surgeries, improving patient outcomes and satisfaction.
• The EPOC program is an institutional quality improvement initiative designed for major spine surgery patients.
• A historically controlled study design was employed to evaluate the EPOC program's impact.

Purpose of the Study:

• To determine if a multidisciplinary Enhanced Perioperative Care (EPOC) program improves clinical and financial outcomes.
• To assess the impact of EPOC on elective adult major spine surgery patients.

Main Methods:

• Comparison of 183 patients in traditional care (TRDC) versus 267 patients in the EPOC program at a single academic center.
• Inclusion of a 108-patient no pathway (NOPW) care group to control for concurrent practice or population changes.
• Primary outcome variables included hospital length of stay (HLOS) and intensive care unit length of stay (ILOS); secondary outcomes were postoperative complications, 30-day readmissions, and cost.

Main Results:

• Significant reductions in mean HLOS (8.2 vs. 6.1 days) and ILOS (3.1 vs. 1.9 days) were observed in the EPOC group compared to TRDC.
• Postoperative ICU admissions were lower in the EPOC group (48% vs. 60%).
• The EPOC program was associated with a significant average cost reduction, from $62,429 to $53,355.

Conclusions:

• The EPOC program significantly reduced HLOS, ILOS, and healthcare costs for major spine surgery patients.
• The initiative demonstrated a clinically relevant contribution to improving patient outcomes and value.
• No significant differences in postoperative complications or 30-day readmissions were noted between groups.