Document Type

Conference Proceeding

Publication Date

5-2026

Publication Title

Global Spine Journal

Abstract

Introduction: Enhanced Recovery After Surgery (ERAS) protocols have been introduced to several surgical specialties with the intention to reduce peri-operative adverse events and improve various health-system quality metrics including length of stay and patient satisfaction. Though this has been studied in the setting of spine surgery, the vast majority are single institution protocols biased toward academic teaching hospitals. There is a paucity of literature studying the utilization of a multi-institutional ERAS protocols that is applicable to community hospitals without associated training programs. We present the Michigan Spine Surgery Improvement Collaborative (MSSIC) two-year experience implementing a multi-institutional ERAS protocol for elective spine surgery. Material and Methods: The MSSIC database was queried for patients across 29 hospitals and three ASCs who underwent elective cervical or lumbar spine surgery from January 2022 to the end of December 2024. Patients were grouped based on whether they underwent the ERAS protocol. The protocol consisted of pre-op measures, including presurgical patient education classes and carbohydrate rich drink prior to surgery; intra-op measures including multimodal opioid sparing analgesia; post-operative measures including ambulation within 8 hours of surgery. Outcomes analyzed include patient demographics, complications, and patient-reported outcomes. A multivariate analysis was conducted to control for confounders. Results: 15,633 patients were included (10,816 lumbar patients and 4817 cervical). Lumbar patients who underwent the ERAS protocol were more likely to be discharge home (RR 1.06; CI 1.03-1.09, p < 0.001), return to work within 90 days (RR 1.24; CI 1.01-1.52, p = 0.04), and achieve MICD in PROMIS functional score at 90 days (RR 1.11; CI > 1.00-1,24, p = 0.04). Notably, lumbar patients undergoing the ERAS protocol were less likely to have a prolonged hospital stay (RR 0.82; CI 0.72-0.93, p = 0.003). Cervical patients who underwent the ERAS protocol were more likely to be discharged home (RR 1.11; CI 1.07- 1.15, p < 0.001) and were less likely to have a prolonged length of stay (RR 0.82; CI 0.69-0.98, p = 0.03) or have a readmission within 30 days (RR 0.65; CI 0.43-0.98, p = 0.04). Conclusion: In our 2-year experience implementing an ERAS protocol in elective spine patients, we have demonstrated its feasibility and potential in decreasing length of stay and 30- day readmissions while increasing home discharge, return to work, and functional status. The use of an elective spine ERAS protocol should be considered by health systems performing elective spine surgery as a quality-improvement driven initiative regardless of multi-institutional status.

Volume

16

Issue

2 Suppl

First Page

8S

Comments

Global Spine Congress, May 27-30, 2026, Istanbul, Turkey

Last Page

9S

DOI

10.1177/21925682261435809

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