• Michael Y Wang, Hsuan Kan Chang, and Jay Grossman.
• Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida.
• Neurosurgery. 2018 Oct 1; 83 (4): 827-834.

BackgroundEnhancing Recovery After Surgery (ERAS®) programs have been widely adopted throughout the world, but not in spinal surgery. In this report, we review the implementation of a "fast track" surgery for lumbar fusion and its effect on acute care hospitalization costs.ObjectiveTo determine if a "fast track" surgery methodology results in acute care cost savings.MethodsThirty-eight consecutive ERAS patients were compared with patients undergoing conventional minimally invasive transforaminal lumbar interbody fusion. Differences between these groups included the use of endoscopic decompression, injections of liposomal bupivacaine, and performing the surgery under sedation in the ERAS® group.ResultsPatients had similar medical comorbidities (2.02 vs 2 for ERAS® and comparator groups, respectively; P = .458). Body mass index was similar (26.5 vs 27.0; P = .329). ERAS® patients were older (65 vs 59 yr, P = .031). Both groups had excellent clinical results with an improvement of 23% and 24%, respectively. Intraoperative blood loss was less (68 ± 31 cc vs 231 ± 73, P < 0.001). Length of stay was also less with ERAS® surgery, at a mean of 1.23 ± 0.8 d vs 3.9 ± 1.1 d (P = 0.009). When comparing ERAS® surgery to standard minimally invasive transforaminal lumbar interbody fusion, the total cost for the acute care hospitalization was $19 212 vs $22 656, respectively (P < 0.001). This reflected an average of $3444 in savings, which was a 15.2% reduction.ConclusionERAS® programs for spinal fusion surgery have the potential to reduce the costs of acute care. This is made possible by leveraging less invasive interventions to minimize soft tissue damage.

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