• Bertrand Debono, Pascal Sabatier, Guillaume Boniface, Philippe Bousquet, Jean-Paul Lescure, Valérie Garnaud, Olivier Hamel, and Guillaume Lonjon.
• Department of Neurosurgery, Neuroscience Pole, Ramsay-Clinique des Cèdres, 31700, Cornebarrieu, France. bdebono@gmail.com.
• Eur Spine J. 2021 Feb 1; 30 (2): 560-567.

PurposeEnhanced recovery after surgery (ERAS), still emerging for the spine, proposes a multimodal approach of perioperative care involving the optimization of every procedural step, with the patient in a proactive position regarding his/her management. We aimed to demonstrate a reduction in the length of hospital stay for ACDF without increasing the risk for patients by comparing 2 groups before and after ERAS implementation using propensity score (PS)-matched analysis.MethodsWe selected 2 periods of 1 year, before (n = 268 patients) and after ERAS implementation (n = 271 patients). Data were collected on patient demographics, operative and perioperative details, 90-day readmissions and morbidity. ERAS-trained nurses were involved to support patients at each pre/per/postoperative step with the help of a mobile app. A satisfaction survey was included. PS analyses were used for dealing with confounding bias in this retrospective observational study.ResultsAfter PS matching, the outcomes of 202 well-balanced pairs of patients were compared (conventional vs ERAS). LOS was reduced from 2.96 ± 1.35 to 1.40 ± 0.6 days (Student, p < 0.001). All 90-day surgical morbidity was similar between the 2 groups, including 30-day readmission (0.5% vs 0%; p = 1), 30- to 90-day readmission (0.5% vs 0.0%; p = 1), 90-day reoperation (0% vs 1%; p = 0.49), major complications (3.0% vs 3.5%; p = 1) and minor complications (2.0% vs 3.5%; p = 0.54). There was no significant difference concerning the satisfaction survey.ConclusionsThe introduction of ERAS for ACDF in our institution has resulted in a significant decrease in LOS, without causing an increase in postoperative complications and has maintained patients' satisfaction.

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