1208 Multi-Institutional Enhanced Recovery After Surgery (ERAS) Protocol in Lumbar Spine Surgery: A Michigan Spine Surgery Improvement Collaborative (MSSIC) Study

INTRODUCTION: Enhanced recovery after surgery (ERAS) protocols have been utilized in various surgical specialties to facilitate decreased post-operative complication rates and length of stay, while improving patient satisfaction. However, there is a paucity of literature analyzing the effects of a multi-institutional ERAS protocol in spine surgery. METHODS: The Michigan Spine Surgery Improvement Collaborative (MSSIC) database was queried for patients across 29 hospitals undergoing elective lumbar spine surgery from January 2017 to December 2019 and from January 2022 to July 2023 when the ERAS protocol was implemented. Multivariate analysis was conducted to compare outcomes of patients in this cohort who underwent the standardized ERAS protocol with those who did not. Outcomes measured include adverse events, timing and disposition of discharge, readmissions, and patient reported outcomes. RESULTS: 5,188 patients were included in this analysis. Patients who underwent the ERAS protocol were more likely to be discharged home (RR = 1.06; CI: 1.03-1.09, p < 0.001) and trended towards being less likely to have a length of stay greater or equal to 3 days (RR = 0.85, CI: 0.71-1.0, p = 0.055). In addition, patients who underwent the ERAS protocol were more likely to achieve a minimal clinically important difference (MCID) in their PROMIS functional score at 90-days (RR 1.14; CI: 1.01-1.29, p = 0.034). There was a trend towards a lower risk of any complications for the ERAS group (RR = 0.80; CI: 0.62-1.03, p = 0.077). CONCLUSIONS: Our statewide multi-institutional ERAS protocol demonstrates potential for cost-saving and improved patient reported outcomes by utilizing an ERAS protocol in elective lumbar spine surgery.