{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T06:46:34Z","timestamp":1792737994580,"version":"4.5.0"},"reference-count":27,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2021,5,21]],"date-time":"2021-05-21T00:00:00Z","timestamp":1621555200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Global Spine Journal"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Retrospective observational cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>We sought to evaluate the impact of ESR on in-hospital and 90-day postoperative opioid consumption, length of stay, urinary catheter removal and postoperative ambulation after lumbar fusion for degenerative conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We evaluated patients undergoing lumbar fusion surgery at a single, multi-surgeon center in the transition period prior to (N = 174) and after (N = 116) adoption of ESR, comparing in-hospital and 90-day postoperative opioid consumption. Regression analysis was used to control for confounders. Secondary analysis was preformed to evaluate the association between ESR and length of stay, urinary catheter removal and ambulation after surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Mean age study participants was 52.6 years with 62 (47%) females. Demographic characteristics were similar between the Pre-ESR and ESR groups. ESR patients had better 3-month pain scores, ambulated earlier, had urinary catheters removed earlier and decreased in-hospital opioid consumption compared to Pre-ESR patients. There was no difference in 90-day opioid consumption between the 2 groups. Regression analysis showed that ESR was strongly associated with in-hospital opioid consumption, accounting for 30% of the variability in Morphine Milligram Equivalents (MME). In-hospital opioid consumption was also associated with preoperative pain scores, number of surgical levels, and insurance type (private vs government). Pre-op pain sores were associated with 90-day opioid consumption. Secondary analysis showed that ESR was associated with a shorter length of stay and earlier ambulation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>This study showed ESR has the potential to improve recovery after lumbar fusion for degenerative conditions with reduced in-hospital opioid consumption and improved postoperative pain scores.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21925682211015652","type":"journal-article","created":{"date-parts":[[2021,5,21]],"date-time":"2021-05-21T05:27:22Z","timestamp":1621574842000},"page":"1030-1035","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":8,"title":["Adoption of Enhanced Surgical Recovery (ESR) Protocol for Lumbar Fusion Decreases In-Hospital Postoperative Opioid Consumption"],"prefix":"10.1177","volume":"13","author":[{"given":"Ehsan","family":"Jazini","sequence":"first","affiliation":[{"name":"Virginia Spine Institute, Reston, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5378-4417","authenticated-orcid":false,"given":"Alexandra E.","family":"Thomson","sequence":"additional","affiliation":[{"name":"Virginia Spine Institute, Reston, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andre D.","family":"Sabet","sequence":"additional","affiliation":[{"name":"Virginia Spine Institute, Reston, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leah Y.","family":"Carreon","sequence":"additional","affiliation":[{"name":"Norton Leatherman Spine Center, Louisville, KA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Roy","sequence":"additional","affiliation":[{"name":"National Spine Health Foundation, Reston, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin M.","family":"Haines","sequence":"additional","affiliation":[{"name":"Virginia Spine Institute, Reston, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas C.","family":"Schuler","sequence":"additional","affiliation":[{"name":"Virginia Spine Institute, Reston, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher R.","family":"Good","sequence":"additional","affiliation":[{"name":"Virginia Spine Institute, Reston, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,5,21]]},"reference":[{"key":"bibr1-21925682211015652","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000002458"},{"key":"bibr2-21925682211015652","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2011.1827"},{"key":"bibr3-21925682211015652","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e31828866b3"},{"key":"bibr4-21925682211015652","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000002133"},{"key":"bibr5-21925682211015652","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2005.02.002"},{"key":"bibr6-21925682211015652","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2019.11.009"},{"key":"bibr7-21925682211015652","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2016.4952"},{"key":"bibr8-21925682211015652","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpa.2015.11.001"},{"key":"bibr9-21925682211015652","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-016-3460-y"},{"key":"bibr10-21925682211015652","doi-asserted-by":"publisher","DOI":"10.3171\/2018.4.SPINE171317"},{"key":"bibr11-21925682211015652","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000001703"},{"key":"bibr12-21925682211015652","doi-asserted-by":"publisher","DOI":"10.3171\/2019.1.FOCUS18692"},{"key":"bibr13-21925682211015652","unstructured":"United States DoHaHS, Centers for Disease Control and Prevention. Calculating total daily dose of opoids for safer dosage. 2018. Updated November 25, 2020. Accessed July 9, 2020. https:\/\/www.cdc.gov\/drugoverdose\/pdf\/calculating_total_daily_dose-a.pdf."},{"key":"bibr14-21925682211015652","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002735"},{"key":"bibr15-21925682211015652","doi-asserted-by":"publisher","DOI":"10.1089\/end.2019.0552"},{"key":"bibr16-21925682211015652","doi-asserted-by":"publisher","DOI":"10.1002\/lary.28768"},{"key":"bibr17-21925682211015652","doi-asserted-by":"publisher","DOI":"10.3171\/2019.1.FOCUS18645"},{"key":"bibr18-21925682211015652","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmig.2019.04.017"},{"key":"bibr19-21925682211015652","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2019.10.007"},{"key":"bibr20-21925682211015652","first-page":"1","author":"Ali ZS","year":"2019","journal-title":"J Neurosurg Spine"},{"key":"bibr21-21925682211015652","doi-asserted-by":"publisher","DOI":"10.1093\/neuros\/nyaa493"},{"key":"bibr22-21925682211015652","doi-asserted-by":"publisher","DOI":"10.1093\/neuros\/nyaa399"},{"key":"bibr23-21925682211015652","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2018.06.034"},{"key":"bibr24-21925682211015652","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000002510"},{"key":"bibr25-21925682211015652","doi-asserted-by":"publisher","DOI":"10.1016\/j.jspd.2016.01.001"},{"key":"bibr26-21925682211015652","doi-asserted-by":"publisher","DOI":"10.1097\/BPO.0000000000000773"},{"key":"bibr27-21925682211015652","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2020.01.010"}],"container-title":["Global Spine Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/21925682211015652","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/21925682211015652","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/21925682211015652","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T07:17:32Z","timestamp":1777447052000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/21925682211015652"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,21]]},"references-count":27,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2023,5]]}},"alternative-id":["10.1177\/21925682211015652"],"URL":"https:\/\/doi.org\/10.1177\/21925682211015652","relation":{},"ISSN":["2192-5682","2192-5690"],"issn-type":[{"value":"2192-5682","type":"print"},{"value":"2192-5690","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,21]]}}}