1565. Enhanced Recovery After Surgery: Elimination of Surgical Drainage Following Lumbar Fusion Reduces Length of Stay

Authors: Stanley Hoang, MD; Mason Rohr; Fassil Mesfin (Columbia, MO)

Introduction: Enhanced recovery after surgery (ERAS) pathways for lumbar fusion aim to promote optimal recovery and reduce length of stay. The ERAS principles synergize the pre-, intra- and postoperative interventions to improve outcome and reduce health care costs. One traditional component of postoperative care is the use of surgical drainage to promote optimal wound healing. To determine whether postoperative drainage affects hospital length of stay and wound healing, we compared outcomes for patients who underwent lumbar fusion at our institution. Methods: A retrospective chart review was performed on patients who underwent open lumbar fusion by a single surgeon over the last 5 years. The patients were categorized into groups who had a hemovac drain and those who did not. Outcomes that were compared included length of stay and wound complications. Results: 167 patients were included in this study, with 134 patients received a postop hemovac and 34 patients did not get a hemovac. The average length of stay for patients who had a hemovac was 2.6 days while the average length of stay for patients who did not have a hemovac was 1.3 days (p < .05). Most hemovac drains were discontinued on POD#1. There was no significant difference in wound related issues. Conclusion: The routine use of surgical drainage following lumbar fusion can increase length of stay. The drain output can bias the surgeon to keep patients in the hospital due to concern for wound related healing. Optimal surgical hemostasis at the end of the operation can reduce the use of surgical drainage and optimize wound healing. The elimination of postoperative drainage is thus an important part of the protocol for an Enhanced Recovery After Surgery (ERAS) pathway to be utilized at our institution following open lumbar fusion.