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Enhanced Recovery after Lumbar Spine Fusion: A Randomized Controlled Trial to Assess the Quality of Patient Recovery.
- Source :
-
Anesthesiology . Aug2020, Vol. 133 Issue 2, p350-363. 14p. - Publication Year :
- 2020
-
Abstract
- <bold>Background: </bold>Prospective trials of enhanced recovery after spine surgery are lacking. We tested the hypothesis that an enhanced recovery pathway improves quality of recovery after one- to two-level lumbar fusion.<bold>Methods: </bold>A patient- and assessor-blinded trial of 56 patients randomized to enhanced recovery (17 evidence-based pre-, intra-, and postoperative care elements) or usual care was performed. The primary outcome was Quality of Recovery-40 score (40 to 200 points) at postoperative day 3. Twelve points defined the clinically important difference. Secondary outcomes included Quality of Recovery-40 at days 0 to 2, 14, and 56; time to oral intake and discharge from physical therapy; length of stay; numeric pain scores (0 to 10); opioid consumption (morphine equivalents); duration of intravenous patient-controlled analgesia use; complications; and markers of surgical stress (interleukin 6, cortisol, and C-reactive protein).<bold>Results: </bold>The analysis included 25 enhanced recovery patients and 26 usual care patients. Significantly higher Quality of Recovery-40 scores were found in the enhanced recovery group at postoperative day 3 (179 ± 14 vs. 170 ± 16; P = 0.041) without reaching the clinically important difference. There were no significant differences in recovery scores at days 0 (175 ± 16 vs. 162 ± 22; P = 0.059), 1 (174 ± 18 vs. 164 ± 15; P = 0.050), 2 (174 ± 18 vs. 167 ± 17; P = 0.289), 14 (184 ± 13 vs. 180 ± 12; P = 0.500), and 56 (187 ± 14 vs. 190 ± 8; P = 0.801). In the enhanced recovery group, subscores on the Quality of Recovery-40 comfort dimension were higher (longitudinal mean score difference, 4; 95% CI, 1, 7; P = 0.008); time to oral intake (-3 h; 95% CI, -6, -0.5; P = 0.010); and duration of intravenous patient-controlled analgesia (-11 h; 95% CI, -19, -6; P < 0.001) were shorter; opioid consumption was lower at day 1 (-57 mg; 95% CI, -130, -5; P = 0.030) without adversely affecting pain scores (-2; 95% CI, -3, 0; P = 0.005); and C-reactive protein was lower at day 3 (6.1; 95% CI, 3.8, 15.7 vs. 15.9; 95% CI, 6.6, 19.7; P = 0.037).<bold>Conclusions: </bold>Statistically significant gains in early recovery were achieved by an enhanced recovery pathway. However, significant clinical impact was not demonstrated. [ABSTRACT FROM AUTHOR]
- Subjects :
- *LUMBAR vertebrae surgery
*MEDICAL quality control
*PREOPERATIVE care
*RESEARCH
*FERRANS & Powers Quality of Life Index
*SPINAL fusion
*CONVALESCENCE
*RESEARCH methodology
*POSTOPERATIVE care
*EVALUATION research
*MEDICAL cooperation
*TREATMENT effectiveness
*COMPARATIVE studies
*RANDOMIZED controlled trials
*BLIND experiment
*IMPACT of Event Scale
*STATISTICAL sampling
*POSTOPERATIVE pain
*LONGITUDINAL method
Subjects
Details
- Language :
- English
- ISSN :
- 00033022
- Volume :
- 133
- Issue :
- 2
- Database :
- Academic Search Index
- Journal :
- Anesthesiology
- Publication Type :
- Academic Journal
- Accession number :
- 144548487
- Full Text :
- https://doi.org/10.1097/ALN.0000000000003346