Enhanced Surgical Recovery

Modernizing the approach to spine surgery recovery

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What Is Enhanced Surgical Recovery?

Enhanced Surgical Recovery (ESR) is a multimodal set of protocols used by your surgical team to help ensure best possible outcomes from your surgery. Important components of ESR occur before, during and after your surgery.

Prior to your surgery, your surgeon will ask for you to obtain certain medical clearances. These clearances ensure that our patient is medically optimized for spine surgery. As patient education is important, your surgeon and surgical team will discuss details of your surgery with you during your pre-operative visit. During this pre-operative visit, we will discuss expectations, restrictions for you after your surgery and pain management. In addition, to ensure optimal nutrition, a surgical carbohydrate beverage is provided for patients to take 4 hours prior to surgery.

During your surgery, the surgical team performs your surgery using the smallest incision possible and optimizes the use of numbing agents to the pain receptors in and around your incision site. In addition, they manage your fluid balance, your pain control, and your body temperature. After your surgery, your surgical team will ensure early removal of any tubes or drains, such as a Foley catheter, and early food intake. In addition, your surgical team will ensure early mobilization with physical therapy and optimize pain control with oral pain medications.

The 3 Stages of ESR

  • Optimize nutrition, fluid balance, and blood sugar control to help prepare patients for improved wound healing and recovery from surgery
  • Nutrition (a pre-surgical carbohydrate beverage is provided)
  • Fluid balance
  • Blood sugar control
  • Nicotine cessation 
  • Proactive pain control – “cocktail of medications” before surgery

During surgery, we use injections to help with muscle pain as well as medications to control bleeding. This is combined with very close attention to fluid balance during surgery with the help of an anesthesiology team.

  • Use of injections to help with muscle pain
  • Use of Tranexamic acid (TXA) medication that helps reduce bleeding
  • Use of nerve medication to decrease pain
  • Use of anti-inflammatory during surgery
  • Optimize fluid balance

  • Eliminate need for IV pain medications to avoid over sedation which slows recovery
  • Ambulate earlier – get patients moving same day or day-after surgery
  • Control pain with short and long acting pain medication 
  • Patients work with a therapist to mobilize their joints and muscles early for faster recovery
  • Continue to optimize nutrition – maintain proper caloric intake, use of protein shakes, vitamins and minerals, and stay hydrated to aid in healing
  • Use anti-inflammatory medication once cleared by your physician
nurse helping happy patient stand in hospital room

What are the benefits of Enhanced Surgical Recovery?

  • Shorter hospital stay
  • Reduced opioid/pain medication use, with better pain control
  • Quicker restoration of pulmonary, urinary and bowel function
  • Optimal recovery of the musculoskeletal system
  • Decreased need for re-admittance to the hospital

Frequently Asked Questions about Enhanced Surgical Recovery (ESR)

ESR is a program meant to allow patients to recover faster from their surgery, by minimizing the impact of surgery on their  body. We took the best available evidence and applied it in a protocol to ensure those are applied to patients before, during, and after surgery.

It is a proven protocol that allows patients to recover faster from surgery, minimizes the need for painkillers, and improves how patients do after surgery.

ESR has been shown to be effective for all spine surgeries no matter how small or large.

As part of our research, we evaluated patients undergoing lumbar fusions 6 months before and after ESR was implemented. The purpose of studying these results was to see how it affected the following four elements:

  • Recovery after surgery
  • Need for painkillers
  • Use of the IV pain medication
  • How soon the patients were walking

We were excited to present our findings at North American Spine Society (NASS); an international meeting of spine surgeons from around the world. We found that after ERAS was implemented our patients needed less pain killers in the hospital, as well as when they went home. Patients also walked faster, and were able to go home earlier. We were able to do this while eliminating the need for the IV pain medication.

Make sure your recovery is as much of a priority as your procedure.

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