Frailty, Myelopathy, and Enhanced Recovery after Surgery in Patients Undergoing Posterior Cervical Fusion

The enhanced recovery after surgery (ERAS) protocol is a proven method to improve postsurgical outcomes. While recent studies have shown the benefit of ERAS even in frail patient populations, myelopathy is another factor affecting outcomes in patients undergoing posterior cervical fusion (PCF). This...

Full description

Saved in:
Bibliographic Details
Published in:World neurosurgery 2024-10, Vol.190, p.e290-e301
Main Authors: Stanton, Amanda N., Yan, Sandra C., Mohamed, Basma, Hoh, Daniel J., Porche, Ken
Format: Article
Language:English
Subjects:
ERAS
Frailty
Myelopathy
PCF
Spine
Citations: Items that this one cites
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
cited_by
cites cdi_FETCH-LOGICAL-c237t-ca8bac807e67a6ce1a189162879ad757aa2701ff1af9ebb52cafcaadda8e0e503
container_end_page e301
container_issue
container_start_page e290
container_title World neurosurgery
container_volume 190
creator Stanton, Amanda N.
Yan, Sandra C.
Mohamed, Basma
Hoh, Daniel J.
Porche, Ken
description The enhanced recovery after surgery (ERAS) protocol is a proven method to improve postsurgical outcomes. While recent studies have shown the benefit of ERAS even in frail patient populations, myelopathy is another factor affecting outcomes in patients undergoing posterior cervical fusion (PCF). This study evaluated the benefit of an ERAS protocol in frail patients undergoing PCF. A retrospective chart review identified consecutive patients undergoing PCF by a single surgeon from August 2015–July 2021, with implementation of ERAS in December 2018. Outcome measures included length of stay (LOS), nonhome discharge disposition, complications, return of physiologic function, and severe pain score. A mFI-5 score of ≥ 2 and a Nurick score of ≥ 3 defined frail and myelopathic patients, respectively. Univariate analysis (P 
doi_str_mv 10.1016/j.wneu.2024.07.113
format article
fullrecord <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_3084774914</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S1878875024012531</els_id><sourcerecordid>3084774914</sourcerecordid><originalsourceid>FETCH-LOGICAL-c237t-ca8bac807e67a6ce1a189162879ad757aa2701ff1af9ebb52cafcaadda8e0e503</originalsourceid><addsrcrecordid>eNp9kE1LAzEQhoMoWtQ_4EFy9GDXZL-SBS9SrAoVxY9zmGZn25RtUpPdSv-9KdUencvMwDMvzEPIBWcJZ7y8WSTfFvskZWmeMJFwnh2QAZdCDqUoq8P9XLATch7CgsXKeC5FdkxOsooVmSz4gJixB9N2m2v6vMHWraCbxxlsTe_tHKzGmr6hdmv0GwpNh56-93623Yylr9AZtF2gn7ZGP3PGzuirC5EyztMR-rXR0NJxH4yzZ-SogTbg-W8_JZ_j-4_R43Dy8vA0upsMdZqJbqhBTkFLJrAUUGrkwGXFy1SKCmpRCIBUMN40HJoKp9Mi1dBogLoGiQwLlp2Sq13uyruvHkOnliZobFuw6PqgMiZzIfKK5xFNd6j2LgSPjVp5swS_UZyprWW1UFvLamtZMaGi5Xh0-ZvfT5dY70_-nEbgdgdg_HJt0Kugo6ao0njUnaqd-S__B6s5kFA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3084774914</pqid></control><display><type>article</type><title>Frailty, Myelopathy, and Enhanced Recovery after Surgery in Patients Undergoing Posterior Cervical Fusion</title><source>ScienceDirect Journals</source><creator>Stanton, Amanda N. ; Yan, Sandra C. ; Mohamed, Basma ; Hoh, Daniel J. ; Porche, Ken</creator><creatorcontrib>Stanton, Amanda N. ; Yan, Sandra C. ; Mohamed, Basma ; Hoh, Daniel J. ; Porche, Ken</creatorcontrib><description>The enhanced recovery after surgery (ERAS) protocol is a proven method to improve postsurgical outcomes. While recent studies have shown the benefit of ERAS even in frail patient populations, myelopathy is another factor affecting outcomes in patients undergoing posterior cervical fusion (PCF). This study evaluated the benefit of an ERAS protocol in frail patients undergoing PCF. A retrospective chart review identified consecutive patients undergoing PCF by a single surgeon from August 2015–July 2021, with implementation of ERAS in December 2018. Outcome measures included length of stay (LOS), nonhome discharge disposition, complications, return of physiologic function, and severe pain score. A mFI-5 score of ≥ 2 and a Nurick score of ≥ 3 defined frail and myelopathic patients, respectively. Univariate analysis (P &lt; 0.05) and multivariate analyses using mixed-effect models (P &lt; 0.0125) were performed. There were a total of 174 patients, 71 frail (41%). Of the frail patients, 61% were also myelopathic, and 56% underwent ERAS. Of the nonfrail patients, 43% were myelopathic, and 57% underwent ERAS. On univariate analyses, frail patients with ERAS had less drains placed (P &lt; 0.0001), decreased urinary retention (P = 0.0002), decreased LOS (P = 0.013), and were less likely to have a nonhome discharge (P = 0.001). On multivariate analysis, LOS (P = 0.0003), time to return of physiologic function (P = 0.004), complications (P = 0.001), and nonhome discharges (P &lt; 0.0001) were decreased with ERAS, irrespective of groups. ERAS is an effective protocol in PCF patients that may expedite return of physiologic function, lessen LOS, decrease the number of nonhome discharges, and reduce complications, irrespective of frailty or myelopathy status.</description><identifier>ISSN: 1878-8750</identifier><identifier>ISSN: 1878-8769</identifier><identifier>EISSN: 1878-8769</identifier><identifier>DOI: 10.1016/j.wneu.2024.07.113</identifier><identifier>PMID: 39053851</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>ERAS ; Frailty ; Myelopathy ; PCF ; Spine</subject><ispartof>World neurosurgery, 2024-10, Vol.190, p.e290-e301</ispartof><rights>2024 Elsevier Inc.</rights><rights>Copyright © 2024 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c237t-ca8bac807e67a6ce1a189162879ad757aa2701ff1af9ebb52cafcaadda8e0e503</cites><orcidid>0000-0003-2985-7799</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27922,27923</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39053851$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Stanton, Amanda N.</creatorcontrib><creatorcontrib>Yan, Sandra C.</creatorcontrib><creatorcontrib>Mohamed, Basma</creatorcontrib><creatorcontrib>Hoh, Daniel J.</creatorcontrib><creatorcontrib>Porche, Ken</creatorcontrib><title>Frailty, Myelopathy, and Enhanced Recovery after Surgery in Patients Undergoing Posterior Cervical Fusion</title><title>World neurosurgery</title><addtitle>World Neurosurg</addtitle><description>The enhanced recovery after surgery (ERAS) protocol is a proven method to improve postsurgical outcomes. While recent studies have shown the benefit of ERAS even in frail patient populations, myelopathy is another factor affecting outcomes in patients undergoing posterior cervical fusion (PCF). This study evaluated the benefit of an ERAS protocol in frail patients undergoing PCF. A retrospective chart review identified consecutive patients undergoing PCF by a single surgeon from August 2015–July 2021, with implementation of ERAS in December 2018. Outcome measures included length of stay (LOS), nonhome discharge disposition, complications, return of physiologic function, and severe pain score. A mFI-5 score of ≥ 2 and a Nurick score of ≥ 3 defined frail and myelopathic patients, respectively. Univariate analysis (P &lt; 0.05) and multivariate analyses using mixed-effect models (P &lt; 0.0125) were performed. There were a total of 174 patients, 71 frail (41%). Of the frail patients, 61% were also myelopathic, and 56% underwent ERAS. Of the nonfrail patients, 43% were myelopathic, and 57% underwent ERAS. On univariate analyses, frail patients with ERAS had less drains placed (P &lt; 0.0001), decreased urinary retention (P = 0.0002), decreased LOS (P = 0.013), and were less likely to have a nonhome discharge (P = 0.001). On multivariate analysis, LOS (P = 0.0003), time to return of physiologic function (P = 0.004), complications (P = 0.001), and nonhome discharges (P &lt; 0.0001) were decreased with ERAS, irrespective of groups. ERAS is an effective protocol in PCF patients that may expedite return of physiologic function, lessen LOS, decrease the number of nonhome discharges, and reduce complications, irrespective of frailty or myelopathy status.</description><subject>ERAS</subject><subject>Frailty</subject><subject>Myelopathy</subject><subject>PCF</subject><subject>Spine</subject><issn>1878-8750</issn><issn>1878-8769</issn><issn>1878-8769</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNp9kE1LAzEQhoMoWtQ_4EFy9GDXZL-SBS9SrAoVxY9zmGZn25RtUpPdSv-9KdUencvMwDMvzEPIBWcJZ7y8WSTfFvskZWmeMJFwnh2QAZdCDqUoq8P9XLATch7CgsXKeC5FdkxOsooVmSz4gJixB9N2m2v6vMHWraCbxxlsTe_tHKzGmr6hdmv0GwpNh56-93623Yylr9AZtF2gn7ZGP3PGzuirC5EyztMR-rXR0NJxH4yzZ-SogTbg-W8_JZ_j-4_R43Dy8vA0upsMdZqJbqhBTkFLJrAUUGrkwGXFy1SKCmpRCIBUMN40HJoKp9Mi1dBogLoGiQwLlp2Sq13uyruvHkOnliZobFuw6PqgMiZzIfKK5xFNd6j2LgSPjVp5swS_UZyprWW1UFvLamtZMaGi5Xh0-ZvfT5dY70_-nEbgdgdg_HJt0Kugo6ao0njUnaqd-S__B6s5kFA</recordid><startdate>20241001</startdate><enddate>20241001</enddate><creator>Stanton, Amanda N.</creator><creator>Yan, Sandra C.</creator><creator>Mohamed, Basma</creator><creator>Hoh, Daniel J.</creator><creator>Porche, Ken</creator><general>Elsevier Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-2985-7799</orcidid></search><sort><creationdate>20241001</creationdate><title>Frailty, Myelopathy, and Enhanced Recovery after Surgery in Patients Undergoing Posterior Cervical Fusion</title><author>Stanton, Amanda N. ; Yan, Sandra C. ; Mohamed, Basma ; Hoh, Daniel J. ; Porche, Ken</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c237t-ca8bac807e67a6ce1a189162879ad757aa2701ff1af9ebb52cafcaadda8e0e503</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>ERAS</topic><topic>Frailty</topic><topic>Myelopathy</topic><topic>PCF</topic><topic>Spine</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Stanton, Amanda N.</creatorcontrib><creatorcontrib>Yan, Sandra C.</creatorcontrib><creatorcontrib>Mohamed, Basma</creatorcontrib><creatorcontrib>Hoh, Daniel J.</creatorcontrib><creatorcontrib>Porche, Ken</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>World neurosurgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Stanton, Amanda N.</au><au>Yan, Sandra C.</au><au>Mohamed, Basma</au><au>Hoh, Daniel J.</au><au>Porche, Ken</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Frailty, Myelopathy, and Enhanced Recovery after Surgery in Patients Undergoing Posterior Cervical Fusion</atitle><jtitle>World neurosurgery</jtitle><addtitle>World Neurosurg</addtitle><date>2024-10-01</date><risdate>2024</risdate><volume>190</volume><spage>e290</spage><epage>e301</epage><pages>e290-e301</pages><issn>1878-8750</issn><issn>1878-8769</issn><eissn>1878-8769</eissn><abstract>The enhanced recovery after surgery (ERAS) protocol is a proven method to improve postsurgical outcomes. While recent studies have shown the benefit of ERAS even in frail patient populations, myelopathy is another factor affecting outcomes in patients undergoing posterior cervical fusion (PCF). This study evaluated the benefit of an ERAS protocol in frail patients undergoing PCF. A retrospective chart review identified consecutive patients undergoing PCF by a single surgeon from August 2015–July 2021, with implementation of ERAS in December 2018. Outcome measures included length of stay (LOS), nonhome discharge disposition, complications, return of physiologic function, and severe pain score. A mFI-5 score of ≥ 2 and a Nurick score of ≥ 3 defined frail and myelopathic patients, respectively. Univariate analysis (P &lt; 0.05) and multivariate analyses using mixed-effect models (P &lt; 0.0125) were performed. There were a total of 174 patients, 71 frail (41%). Of the frail patients, 61% were also myelopathic, and 56% underwent ERAS. Of the nonfrail patients, 43% were myelopathic, and 57% underwent ERAS. On univariate analyses, frail patients with ERAS had less drains placed (P &lt; 0.0001), decreased urinary retention (P = 0.0002), decreased LOS (P = 0.013), and were less likely to have a nonhome discharge (P = 0.001). On multivariate analysis, LOS (P = 0.0003), time to return of physiologic function (P = 0.004), complications (P = 0.001), and nonhome discharges (P &lt; 0.0001) were decreased with ERAS, irrespective of groups. ERAS is an effective protocol in PCF patients that may expedite return of physiologic function, lessen LOS, decrease the number of nonhome discharges, and reduce complications, irrespective of frailty or myelopathy status.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>39053851</pmid><doi>10.1016/j.wneu.2024.07.113</doi><orcidid>https://orcid.org/0000-0003-2985-7799</orcidid></addata></record>
fulltext fulltext
identifier ISSN: 1878-8750
ispartof World neurosurgery, 2024-10, Vol.190, p.e290-e301
issn 1878-8750
1878-8769
1878-8769
language eng
recordid cdi_proquest_miscellaneous_3084774914
source ScienceDirect Journals
subjects ERAS
Frailty
Myelopathy
PCF
Spine
title Frailty, Myelopathy, and Enhanced Recovery after Surgery in Patients Undergoing Posterior Cervical Fusion
url http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-14T08%3A34%3A50IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Frailty,%20Myelopathy,%20and%20Enhanced%20Recovery%20after%20Surgery%20in%20Patients%20Undergoing%20Posterior%20Cervical%20Fusion&rft.jtitle=World%20neurosurgery&rft.au=Stanton,%20Amanda%20N.&rft.date=2024-10-01&rft.volume=190&rft.spage=e290&rft.epage=e301&rft.pages=e290-e301&rft.issn=1878-8750&rft.eissn=1878-8769&rft_id=info:doi/10.1016/j.wneu.2024.07.113&rft_dat=%3Cproquest_cross%3E3084774914%3C/proquest_cross%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c237t-ca8bac807e67a6ce1a189162879ad757aa2701ff1af9ebb52cafcaadda8e0e503%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=3084774914&rft_id=info:pmid/39053851&rfr_iscdi=true