Purpose: The number and cost of spine surgeries have increased over the past decade. Various perioperative interventions continue to provide care for spine surgical patients despite evidence indicating that Enhanced Recovery After Surgery (ERAS) consistently decreases the stress response to surgery and improves patient outcomes.

Methods: A multidisciplinary evidence-based quality improvement (QI) project was implemented in a community-based acute care facility to address an identified gap in best practice. As the gold standard in perioperative care, the ERAS protocol provided a preoperative oral carbohydrate drink (CHO), acetaminophen, and gabapentin to existing interventions for a more complete ERAS spine bundle.

Results: This scholarly quality improvement (QI) project found a statistically significant reduction in total morphine milligram equivalents (TMME) required in the post-anesthesia recovery unit (PACU). Patients had improved comfort that was not statistically significant, in the PACU with a reduction in the need for postoperative nausea and vomiting (PONV) medications, and the length of stay (LOS) in the PACU increased slightly but was not statistically significant.

Discussion: Enhanced Recovery After Surgery (ERAS) guidelines are reproducible evidenced-based practice models with a known impact on patient outcomes and satisfaction without an increase in readmission or complications. The use of a QI ERAS spine bundle found that patients not only required less narcotics in the PACU but also needed less PONV medication for comfort. This QI ERAS bundle is evidence that the use of multimodal analgesia and CHO combined with existing ERAS spine interventions is vital not only to reduce patient exposure to unnecessary narcotics but improve comfort. Individually, these interventions do not appear impactful, but patient outcomes are positively impacted when bundled together in a care bundle or model. LOS can be a challenge to quantify and evaluate for accuracy when bed and staffing shortages are a constant problem to patient recovery and workflow in a facility post-pandemic. For the future, a better LOS measurement could have been the arrival time in PACU to discharge home. Additional QI ERAS projects evaluating patients’ TMME post-surgery to discharge home, and patients’ satisfaction surveys would be a valid next step in improving an ERAS spine bundle. These findings also show the impact of inexpensive and simple interventions for other surgical specialties in reducing TMME and improving patient comfort.