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Comparison of ERAS-Based Same-Day and Non-Same Day Protocols in IDEM Spinal Cord Tumor Surgeries : A Propensity
Sang Hoon Hwang1, Subum Lee2, Seung Jun Ryu3
1Department of Neurosurgery Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea.
Objective:
We developed ERAS-based same-day surgery (SDS) and non-same-day surgery (non-SDS) protocols for intradural extramedullary (IDEM) spinal cord tumor surgeries, which were implemented in 2022. This study compared healthcare costs, and clinical and surgical outcomes between SDS and non-SDS protocols and describes how they are applied in practice.
Methods:
This retrospective study included 173 patients who underwent surgery for IDEM spinal cord tumors performed by a single neurosurgeon at single institution between 2022 and 2024. All patients were managed under an ERAS-based protocol: 58 receiving the SDS protocol and 115 managed under the non-SDS protocol. Propensity score matching was performed using six variables, resulting in 48 matched pairs. Surgical outcomes included operative time, estimated blood loss, the presence of residual tumor on postoperative imaging, and postoperative complications. Clinical outcomes were assessed using the visual analog scale (VAS) for pain, modified McCormick scale, the American Spinal Injury Association (ASIA) Impairment scale, Karnofsky Performance Status (KPS) scale, Eastern Cooperative Oncology Group (ECOG) performance status, a 5-point Likert scale for surgical satisfaction, and 30-day readmission rates. Healthcare costs were analyzed using a detailed itemized statement of medical expenses.
Results:
There were no significant differences in surgical or clinical outcomes between the groups. The SDS group had a shorter length of stay (LOS; 4.1 vs. 5.6 days) and lower total hospital costs, with an average cost reduction of approximately 1,200 US dollars (USD). Facility costs showed the largest difference (600 USD) between the groups.
Conclusion:
ERAS-based SDS and non-SDS protocols for IDEM spinal cord tumor surgery show similar surgical and clinical outcomes. However, ERAS-based SDS protocols significantly reduce LOS and total hospital costs. Therefore, this protocol-driven SDS approach can be considered a feasible and cost-effective strategy for carefully selected patients with IDEM spinal cord tumors.
