Shorter Recovery After Spine Surgery
NeurosurgeryOne back doctors, in coordination with Littleton Adventist Hospital, are using a new back surgery program that helps patients regain function quicker. The new program, called Enhanced Recovery After Surgery (ERAS), also decreases use of opioids and reduces complications from spine surgery—leading to a better overall patient experience.
NeurosurgeryOne’s spine doctors use the ERAS program for all back surgery and neck surgery patients at Littleton Adventist Hospital who are being treated for conditions that cause lower back pain and neck pain. This ERAS program, offered exclusively by NeurosurgeryOne spine surgeons at Littleton Adventist Hospital, is the first in the Denver area.
According to a review of ERAS studies published in Neurosurgical Focus in April 2019, the benefits of ERAS include:
- Faster functional recovery
- Shorter hospital says
- Decreased opioid use
- Reduced surgery complications
- Improved patient satisfaction
How do I get ready for back surgery?
Preparing for back surgery or neck surgery is an important component to a successful outcome, and it’s a primary component of the ERAS pathway. At NeurosurgeryOne, we offer our spine surgery patients and their families a “prehab” spine clinic, if they are having surgery at Littleton Adventist Hospital. Patients who receive education and instructions before surgery are much more likely to remember things compared to patients who receive the same information after surgery when they’re in pain and uncomfortable. In the ERAS spine clinic, patients will undergo:
- Appropriate diagnostic testing, such as EKG and blood tests, and medical clearance for surgery to ensure patients are healthy and ready for the rigors of surgery
- Preoperative risk assessment to reduce patients’ opioid use, optimize their presurgical nutrition, and help them to quit smoking prior to surgery
- Depression screening since research shows depression can lead to increased pain, longer recovery times, more postsurgical complications, and failure to comply with medication schedules
- Physical therapy assessment to help develop a customized rehabilitation plan for you after your surgery.
Separate from the spine surgery prehab clinic, you and your caregivers will attend a spine surgery class. This class will help you prepare for your return home after surgery and teach you steps to improve your recovery and regain function. You will learn:
- How to optimize your diet, such as increasing lean protein intake before and after surgery, which helps with wound healing
- Preparing your home and daily routine for after surgery, such as how to get dressed, make the bed, and use the toilet
- Medications used before, during, and after surgery, and how to set realistic pain goals
- What to expect both in the hospital and after discharge in terms of recovery and wound care
- Whom to contact with questions and signs to watch for
- How to safely bend, lift, and twist after surgery, as demonstrated by a physical therapist
Before the spine clinic, we contact your primary care physician to get your past medical history and understand any potential health problems. To reduce the risk of complications during surgery, the ERAS team also will talk to you about smoking cessation, reducing opioid use, and optimizing your nutrition to best prepare your body for surgery and recovery. By taking steps before surgery, stress during back surgery and complications after back surgery are both decreased.
After the class, you will receive an informational folder that includes information on everything discussed during class as well as contact information for your surgeon and team, including your nurse navigator. You’ll also be sent home with sugarless gum and candy to use after surgery to help wake up your gut, clear carbohydrate loading drinks to ingest before surgery, and chlorhexidine wipes with instructions on how to use them for preoperative cleaning.
How does ERAS help during and after back surgery?
During back surgery and neck surgery, ERAS spine patients receive medications that help control their pain and minimize opioid use. For example, you may receive IV methadone, as well as a non-opioid analgesic called Exparel, which is injected at the incision site and slowly breaks down. Both medications provide pain control for up to 12 to 72 hours after surgery. These longer-lasting pain medications help provide a bridge to the other types of medications patients will start taking such as Celebrex and gabapentin rather than opioids.
After spine surgery, ERAS focuses on getting patients up and moving as soon and as much as possible, including being out of bed for every meal. Movement helps stretch the muscles and gets oxygen to them, which helps with pain and healing. But don’t worry, a physical therapist or member of the nursing staff will be by your side to help you learn how to stand up and move safely.
Most ERAS patients go home sooner after back surgery than non-ERAS patients. They also usually have a significant reduction in narcotics use than non-ERAS patients — some with zero narcotics use upon discharge. Patients are prescribed alternative scheduled medications, including muscle relaxers, prescription-strength anti-inflammatory medications, and Tylenol, which all work on different pain receptors in the brain.
Wound healing also occurs faster after surgery with ERAS, which means fewer patients end up back in the hospital. If you do have concerns about your wound, you will be prepared through your spine classes to know what to do or you can contact your nurse navigator who can reach your surgeon immediately, if needed. During the spine class, you will receive detailed education about post-surgical expectations, including what’s normal and when to call your surgical team.
To learn more about ERAS for quicker spine surgery recovery or register for a Spine Class, call NeurosurgeryOne Spine Nurse Navigator Kelly Boals, RN, BSN, at 303-925-4915.