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Nancy McLaughlin, Farzad Buxey, Karen Chaw and Neil A. Martin

series, an optimal surgical care episode, with satisfaction of all 9 key outcome measures, was achieved in 5% of patients in Group 1 and 31% of patients in Group 2 (p = 0.034). As noted in various experiences with care-bundle practices and system-wide quality improvement initiatives, “optimal surgical care” is a much more challenging goal than satisfaction of individual criteria. Avenues for Future Improvement Enhanced Recovery After Surgery Perioperative Management Protocols Enhanced recovery after surgery (ERAS) perioperative protocols are multimodal and

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Bobby D. Kim, Timothy R. Smith, Seokchun Lim, George R. Cybulski and John Y. S. Kim

redirected toward individual and systems-based practices for preventing complications. Recent endeavors to accomplish this include the Comprehensive Unit-Based Safety Program (CUSP) 69 and the Enhanced Recovery After Surgery (ERAS) program by the UK National Health Service, 54 both of which are intended to decrease perioperative complication rates, facilitate discharge, and reduce hospital readmissions. Though not universally applicable, some of the adoptable recommendations include standardization of skin preparation, administration of preoperative chlorhexidine showers

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Nancy McLaughlin, Pooja Upadhyaya, Farzad Buxey and Neil A. Martin

cost more than an actual cost reduction for the whole episode of surgical care. Delivering certain elements of care in an outpatient setting instead of an inpatient setting may remain cost efficient overall. 50 Recently, multidisciplinary perioperative protocols that enhance recovery after surgery by implementing evidence-based best practices throughout a patient's entire care episode have been shown to improve outcome and decrease the cost of care. 6 , 10 , 16 , 27 , 35 , 37 In the present study, in addition to revisiting postoperative bed assignment, we achieved

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Nancy McLaughlin, Matthew C. Garrett, Leila Emami, Sarah K. Foss, Johanna L. Klohn and Neil A. Martin

April 2013, the Department of Neurosurgery at UCLA launched a multidisciplinary and multidepartmental care redesign strategy initiative, called NERVS (Neurosurgery Enhanced Recovery after surgery, Value, and Safety), to improve neurosurgery valued care. As we assessed the current state of our clinical processes, clinical outcomes, and cost of care delivery, we recognized the importance of integrating additional unconventional data as we strategized to improve the value of delivered care. Comprehensive assessment of our baseline safety events, patient satisfaction data

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Karthik Madhavan, Lee Onn Chieng, Hanyao Foong and Michael Y. Wang

in patients more than 75 years of age . Spine (Phila Pa 1976) 24 : 529 – 534 , 1999 26 McDonald R : Enhanced recovery clinical education programme improves quality of postoperative care . BMJ Qual Improv Rep 4 : u208370.w3387 2015 27 Merchant RN , Davies JM : Fluid management issues in Enhanced Recovery After Surgery and Canadian Anesthesiologists' Society standards . Can J Anaesth 62 : 930 , 2015 . (Letter) 28 Miller TE , Roche AM , Mythen M : Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After

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-DSPNABSTRACTS Kline Peripheral Nerve Award Presentation 141. Reduction of Postoperative Narcotic Consumption in Awake TLIF: Enhanced Recovery After Surgery Karthik Madhavan , MD , Hsuan-Kan Chang , MD , Timur Urakov , MD , Lee Onn Chieng , Anand Veeravagu , MD , and Michael Y. Wang , MD, FACS 3 2017 42 3 Peripheral Nerve A13 A13 Copyright held by the American Association of Neurological Surgeons. You may not sell, republish, or systematically distribute any published materials without written

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Michael Y. Wang, Peng-Yuan Chang and Jay Grossman

T he Enhancing Recovery After Surgery (ERAS) movement began in Denmark as a practice concept integrating multidisciplinary, perioperative care programs. Previously known as “fast-track surgery” or “enhanced recovery programs,” it started to gain ground in the 1990s by aiming to reduce the length of hospitalization after elective abdominal surgery through integrated approaches to maintain cardiovascular, pulmonary, neurological, gastrointestinal, and endocrine homeostatic functions. 9 , 10 Traditionally, a patient's surgical journey has been broken into

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Development of an Enhanced Recovery After Surgery (ERAS) approach for lumbar spinal fusion Michael Y. Wang Peng-Yuan Chang Jay Grossman 4 2017 26 4 411 418 10.3171/2016.9.SPINE16375 2016.9.SPINE16375 Effects of intradiscal vacuum phenomenon on surgical outcome of lateral interbody fusion for degenerative lumbar disease Chun-Po Yen Joshua M. Beckman Andrew C. Vivas Konrad Bach Juan S. Uribe 4 2017 26 4 419 425 10.3171/2016.8.SPINE16421 2016.8.SPINE16421 Mesenteric ischemia following the correction of adult spinal deformity: case report Krishn Khanna Sigurd

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Orlando, Florida • March 14–17, 2018

(5.4% vs 3.7%, p=0.23) and 30-days reoperation rate (5.4% vs 1.5%, p=0.14) were evidenced in opiod group. Conclusion: In this study, we demonstrated worse outcome for those patient consume narcotic preoperatively. A strong effort of avoiding prescribing narcotic is desperately needed. In our institution, we have recently introduced Enhanced Recovery After Surgery protocol which has proved to improve outcome and reduce narcotic requirement. 122 Use of Polyetheretherketone Interbody Devices for One-level Anterior Cervical Discectomy and Fusion Results in a Five

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New Orleans, LA • April 29–May 2, 2018

the use of critical care services, and not having an interdisciplinary co-management model was an independent predictor of need for critical care services (i.e. transfer to ICU). 401. Nursing efforts in spine and peripheral nerve enhanced recovery after surgery (ERAS) pathway implementation and outcomes Advanced Practice Provider (APP) Abstract Award Kristin Rupich, MSN (Philadelphia, PA); Mara Cappelloni; Emily Missimer; Diana Gardiner; Benjamin Hurtig; Rachel Pessoa; Albert Abbo; Ali Ozturk; William Welch; Zarina Ali Introduction: Optimization of postoperative