Patient outcomes following implementation of an enhanced recovery after surgery pathway for patients with metastatic spine tumors

Background: Metastatic spine tumor surgery consists of palliative operations performed on frail patients with multiple medical comorbidities. Enhanced recovery after surgery (ERAS) programs involve an evidence-based, multidisciplinary approach to improve perioperative outcomes. This study presents clinical outcomes of a metastatic spine tumor ERAS pathway implemented at a tertiary cancer center. Methods: The metastatic spine tumor ERAS program launched in April 2019, and data from January 2018 to May 2020 were reviewed. Measured outcomes included the following: hospital length of stay (LOS), time to ambulation, urinary catheter duration, time to resumption of diet, intraoperative fluid intake, estimated blood loss (EBL), and intraoperative and postoperative day 0–5 cumulative opioid use (morphine milligram equivalent [MME]). Results: A total of 390 patients were included in the final analysis: 177 consecutive patients undergoing metastatic spine tumor surgery enrolled in the ERAS program and 213 consecutive pre-ERAS patients. Although the mean case durations were similar in the ERAS and pre-ERAS cohorts (265 vs. 274 min; p =.22), the ERAS cohort had decreased EBL (157 vs. 215 ml; p =.003), decreased postoperative day 0–5 cumulative mean opioid use (178 vs. 396 MME; p <.0001), earlier ambulation (mean, 34 vs. 57 h; p =.0001), earlier discontinuation of urinary catheters (mean, 36 vs. 56 h; p <.001), and shorter LOS (5.4 vs. 7.5 days; p <.0001). Conclusions: The implementation of a multidisciplinary ERAS program designed for metastatic spine tumor surgery led to improved clinical quality metrics, including shorter hospitalizations and significant reductions in opioid consumption.