gms | German Medical Science

Objective: The Rapid Recovery program is an evidence-based structured approach to optimize patient care. In recent years, Rapid Recovery has been successfully established as care concept in hip, knee and shoulder arthroplasty already. The aim was now to apply this treatment approach to the care of patients undergoing mono- and bisegmental lumbal spinal fusion and thus create a basis for evidence-based and structured treatment in spinal surgery.

Method: At the beginning the focus was laid on patient education. To meet the patients' need, a "Spine School" gives information about the disease and the surgical treatment, practical physiotherapy exercises and individual education by all professional groups. On the basis of the results of international studies, the creation of a structured and evidence-based care pathway, which optimizes intraoperative blood loss, the adaptation of the intra- and postoperative pain management, the postoperative wound and drainage management, early mobilization on the day of surgery and the definition of specific qualitative discharge criteria was developed.

Results: Since January 2013, 202 patients undergoing mono- and bisegmental lumbar spinal fusion (mean age 56.7 years, 23 - 84 years) were included in the developed treatment concept. 98% of patients rated the performance of patient school very good or good and would recommend the Rapid Recovery program. Perioperatively, a reduction of blood loss by 20% was obtained. In 85% of all cases, the mobilization at the day of surgery was possible. Due to the improved patient information and increased cooperation, as well as to the early postoperative mobilization, and to the structured discharge management with fixed quality discharge criteria, a reduction in the average hospital stay of 12.7 days in 2012 to 6.7 days in 2013 and 6.2 days could be observed in 2014. Despite the reduction in length of hospital stay, no increase in readmission to the hospital was found at a consistently low postoperative complication rate.

Conclusions: With the Rapid Recovery program a structured treatment approach has been developed, allowing optimal evidence-based care for patients, starting at the first outpatient contact, including the surgical treatment all the way to discharge and beyond. The treatment concept is characterized by a high degree of patient satisfaction, early mobilization and optimization of perioperative management and has the potential to lead to a reduction of length of hospital stay.