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Perioperative Protocol for Elective Spine Surgery Is Associated With Reduced Length of Stay and Complications

Introduction: Healthcare reform places emphasis on maximizing the value of care. Methods: A prospective registry was used to analyze outcomes before (1,596 patients) and after (151 patients) implementation of standardized, evidence-based order sets for six high-impact dimensions of perioperative care for all patients who underwent elective surgery for degenerative spine disease after July 1, 2015. Results: Apart from symptom duration, chronic obstructive pulmonary disease prevalence, estimated blood loss, and baseline Oswestry Disability Index, no significant differences existed between pre- and post-protocol cohorts. No differences in readmissions, discharge status, or 3-month patient-reported outcomes were seen. Multivariate regression analyses demonstrated reduced length of stay (P = 0.013) and odds of 90-day complications (P = 0.009) for postprotocol patients. Conclusion: Length of stay and 90-day complications for elective spine surgery improved after implementation of an evidence-based perioperative protocol. Standardization efforts can improve quality and reduce costs, thereby improving the value of spine care. Level of Evidence: Level III (retrospective review of prospectively collected data)