Enhanced Recovery after Surgery (ERAS) and its applicability for major spine surgery

Clinical AnaesthesiologyTom Wainwright’s paper written in collaboration with Tikki Immins and Rob Middleton, titled “Enhanced Recovery after Surgery (ERAS) and its applicability for major spine surgery” was accepted for publication in March 2016 in Best Practice & Research: Clinical Anaesthesiology.  Tom  is an expert in Enhanced Recovery after Surgery (ERAS) pathways and has published widely. He is the first person to apply enhanced recovery principles to complex spinal surgery.

The demand for major spinal surgery is increasing, over 10,000 spinal fusion operations were recorded in 2013/14, a 20% increase from 2011/12, and in the US a 15-fold increase in the rate of complex fusion procedures was reported from 2002 to 2007. At present there are wide variations in length of stay, complication rates, post-operative pain and functional recovery suggesting that improvements are possible.  The literature suggests that components of ERAS used in isolation, such as patient education, multimodal pain management, blood loss strategies and physiotherapy can be successful. These findings, combined with the success of ERAS in other procedures, are indicative that ERAS pathways should be applicable to major spinal surgery patients. Given the significant potential improvements to patient recovery if ERAS principles can be successfully integrated, the adoption and careful evaluation of ERAS pathways should be a priority for major spinal surgery multi-disciplinary teams.

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