Enhanced recovery pathways (ERP) after surgery have been shown to decrease length of stay and perioperative complications in a range of surgical specialties. To date, ERPs has not been studied in patients presenting for spine surgery. The investigators have recently developed an interdisciplinary pathway for spine surgery patients based on the latest available evidence and guidelines. The aim of this trial is to compare the investigators enhanced recovery pathway with conventional perioperative management in patients undergoing 1-2 level posterior lumbar fusion.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
DOUBLE
Enrollment
56
The study team emphasizes that all components of the ERP are considered standard of care at this institution. The objective of this study is to ensure that the study patients assigned to the ERP will receive these standard of care components.
Hospital for Special Surgery
New York, New York, United States
Patient Score on QoR40 Inventory.
The Quality of Recovery 40 (QoR40) is a 40-item questionnaire which assesses five dimensions of recovery after surgery and anesthesia: comfort, emotions, physical independence, patient support and pain. The QoR40 has been validated for both clinical and research use. The QoR-40 has a possible score of 40 (extremely poor quality of recovery) to 200 (excellent quality of recovery).
Time frame: Postoperative Day 3
Length of Stay and Time From Surgery to Meeting Discharge and Physical Therapy Goals.
Measured in days after surgery (in half-day increments).
Time frame: Postoperative Day 5
Pain Control: Opioid Consumption.
Measured in morphine equivalents daily.
Time frame: 48 hours after surgery
Pain Control: NRS Rating Scales of Pain After Physical Therapy on Postoperative Day 1
Scale of 0-10, 0 being no pain, 10 being the worst pain possible
Time frame: Postoperative Day 1
Time to Post-operative Oral Intake.
Measured in hours
Time frame: Postoperative Day 1
Number of Participants With Post-operative Nausea, Vomiting and Ileus
If the patient ever had any of the events of nausea, vomiting, ileus by day of discharge
Time frame: Postoperative Day 5
Levels of Plasma Markers of Surgical Stress: IL-6 (pg/ml).
Time frame: Postoperative Days 0, 1, and 3
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Levels of Plasma Markers of Surgical Stress: Cortisol (mcg/dl).
Time frame: Postoperative Days 0, 1, and 3
Levels of Plasma Markers of Surgical Stress: CRP (mg/dL).
Time frame: Postoperative Days 0, 1, and 3
Levels of Plasma Markers of Surgical Stress: Insulin Resistance (µIU/ml).
Time frame: Postoperative Days 0, 1, and 3
Number of Participants With Presence of Delirium/Confusion, Infection, DVT/PE
Incidence of patients with event of delirium/confusion, infection, DVT/PE will be assessed for the entire hospital admission but measured at discharge.
Time frame: Entire Hospital Admission, but Measure at Discharge (Up to Postoperative Day 5)