Reduced acute care costs with the ERASR minimally invasive transforaminal lumbar interbody fusion compared with conventional minimally invasive transforaminal lumbar interbody fusion

Michael Y. Wang, Hsuan Kan Chang, Jay Grossman

Research output: Contribution to journalArticle

17 Scopus citations


BACKGROUND: Enhancing Recovery After Surgery (ERAS R ) programs have been widely adopted throughout the world, but not in spinal surgery. In this report, we review the implementationofa“fasttrack”surgeryforlumbarfusionanditseffectonacutecarehospi-talization costs. OBJECTIVE: To determine if a “fast track”surgery methodology results in acute care cost savings. METHODS: Thirty-eight consecutive ERAS patients were compared with patients undergoing conventional minimally invasive transforaminal lumbar interbody fusion. Differences between these groups included the use of endoscopic decompression, injections of liposomal bupivacaine, and performing the surgery under sedation in the ERAS R group. RESULTS: Patients had similar medical comorbidities (2.02 vs 2 for ERAS R and comparator groups, respectively; P= .458). Body mass index was similar (26.5 vs 27.0; P= .329). ERASR patients were older (65 vs 59 yr, P= .031). Both groups had excellent clinical results with an improvementof23%and24%,respectively.Intraoperativebloodlosswasless(68±31ccvs 231±73,P<0.001).LengthofstaywasalsolesswithERAS R surgery,atameanof1.23±0.8d vs 3.9 ± 1.1 d (P= 0.009). When comparing ERAS R surgery to standard minimally invasive transforaminal lumbar interbody fusion, the total cost for the acute care hospitalization was$19212vs$22656,respectively(P<0.001).Thisreflectedanaverageof$3444insavings, which was a 15.2% reduction. CONCLUSION: ERAS R programs for spinal fusion surgery have the potential to reduce the costs of acute care. This is made possible by leveraging less invasive interventions to minimize soft tissue damage.

Original languageEnglish (US)
Pages (from-to)827-834
Number of pages8
JournalClinical neurosurgery
Issue number4
StatePublished - Jan 1 2018



  • Anesthesia
  • Cost
  • Economic
  • Enhancing recovery
  • ERAS
  • Exparel
  • Minimally invasive
  • Pedicle screw
  • Percutaneous
  • QALY
  • Spine

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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