Enhanced Recovery After Surgery (ERAS)

Spine Center ERAS

Appointment New Patient Appointment or 214-645-8300

Our multidisciplinary approach to care brings together a diverse group of specialists to partner with our patients in their recovery. Our Spine Center experts include neurosurgeons, orthopedic surgeons, psychologists, rehab specialists, anesthesiologists, internal medicine doctors, geriatricians, nurses, dietitians, and physical therapists.

Goals

  • Improve our patients' overall experience, outcomes, and satisfaction related to surgery.
  • Reduce the stress associated with complex spine surgery.
  • Reduce the occurrence of surgically-related complications.
  • Speed the return to more normal activities.
  • Reduce costs.
  • Improve outcomes.

Prior to Surgery

Please take a few minutes to watch our Spine Center video that gives an overview of the surgical experience from pre-surgery to recovery. You will see our facilities and meet some of the physicians and staff from the UT Southwestern Spine Program.

Medical Clearances

Your surgeon may request that you complete these appointments prior to surgery:

  • General Internal Medicine Pre-Op Clinic Appointment: This appointment includes a full head-to-toe assessment by an internist. This appointment is needed for patients that may have a complex medical history and need an assessment to confirm that they are appropriate for general anesthesia.
  • Perioperative Optimization of Senior Health (POSH): This program is aimed at providing a comprehensive evaluation of older adults who are planning to undergo surgery. This appointment includes a pre-operative evaluation to anticipate your individual risks related to surgery, and the development of a plan to optimize your health status throughout the surgical period to ensure the best possible outcome.
  • Cardiac Clearance: Your surgeon may request that a clearance be completed by your cardiologist if you are currently on an anticoagulant (i.e. Xarelto, Eliquis, Coumadin) and/or have a medical history of cardiac issues.
  • Behavioral Health Evaluation: This appointment includes a full assessment by a psychologist to help ensure your optimal recovery and that you have an understanding of the expectations, goals, recovery and treatment plan in place.

Pre-surgery Testing

Your pre-surgery testing will be scheduled at Zale Lipshy Pavilion. You will be contacted via phone or MyChart with a pre-surgery testing date and time and your post-op clinic appointment. This appointment includes a lab draw, speaking with the anesthesia team, and a pre-surgery testing nurse. They will discuss your current medications, medical history, and information regarding your surgery (i.e. time to arrive the day or surgery, preparations for the night before surgery, where to park). You do not need to fast prior to your pre-surgery testing appointment. Pre-surgery testing is a requirement. Failure to attend may result in your surgery being canceled. Please make every effort to attend.

ERAS Patient Class

In addition to printed materials, we offer an in-person and virtual patient class that reinforces important aspects of the surgical experience and also provides an opportunity to ask questions of the clinical team. We also offer a tour of the inpatient unit where you will be staying.

Pre-surgery Rehabilitation Program

Your surgeon may request that you complete a pre-surgical rehabilitation program. The goals of this program are to improve strength, endurance, and functional mobility prior to surgery in order to optimize your recovery after surgery. A physical therapist will meet with you over one or more sessions to design a customized program to address your specific needs, and to prepare you for the rehabilitation process after surgery.

Smoking Cessation

Recovering from surgery will be significantly easier if you quit smoking. Smoking puts stress on your body, decreasing blood flow to major organs, reducing your oxygen intake, lowering your overall ability to heal, and increasing risk of complications. For these reasons, we require that any patients undergoing surgery with us stop smoking at least 6 weeks prior to surgery. Your provider and healthcare team can help you be successful, as can your primary care physician. Several prescription medications are available to reduce nicotine cravings. We can also refer you to the smoking cessation program here at UT Southwestern, as well as support groups in the area.

Nutrition

Nutrition is a key component of your surgical recovery. Food nourishes you and helps your body heal and better tolerate the stress of surgery. There are many areas to consider with nutrition such as protein needs, inflammation, vitamins and minerals, and constipation. If you are malnourished or as risk for malnutrition, it is important to improve your nutritional status before surgery in order to help reduce the risk of complications. You may supplement your food intake with high protein drinks such as Boost® or Ensure®. You should drink one, two times per day starting approximately 2 weeks prior to your surgery.

Weight Management

The ideal BMI (Body Mass Index) for someone undergoing spine surgery is 20-25. Over 25 is considered overweight and over 30 is considered obese. Obesity may contribute to increased rate of disc degeneration, spinal arthritis, and low back pain. Having a BMI greater than 30 puts you at risk for post-operative complications including DVT, surgical site infection, longer surgery time, difficulty with pain control, breathing problems related to anesthesia, and increased blood loss during surgery. Working to improve your weight management both pre- and postoperatively will help improve your outcome from surgery and reduce the risk for future problems. You should consult your primary care physician before starting an exercise routine, changing your diet, or taking nutritional supplements.

Your Inpatient Stay

During your inpatient stay, a team of doctors, advanced practice providers, nurses, and therapists will assist with your care. Your surgeon will direct your care in the acute care phase of your recovery. Someone from the surgical team will see you and examine you each day that you are in the hospital. Please be assured that your surgeon is aware of your condition, even though another team member may be the one seeing you at any given moment.

  • Most patients stay 2 to 5 days following their surgery, although some may require a longer stay based on how quickly you are healing and other factors.
  • Physical therapy will begin the day after surgery in the hospital.
  • Physical and occupational therapists will evaluate you daily.
  • It is recommended that you walk a minimum of 3 times a day in addition to your therapy sessions.
  • If you require inpatient acute rehabilitation at Zale Lipshy, the rehab team and physicians will assume primary responsibility for your day-to-day care and management.
  • Your surgical team will work with the rehab team and will be readily available to you should any surgery-related issues or concerns arise.
  • Any DME (durable medical equipment) that you may need will be arranged upon your discharge from the hospital.

Post-Operative Care

It is recommended that a family member or friend stay with you in the week following discharge from the hospital. You will need help with daily activities as you will be moving slow and will likely have restrictions to follow. General post-operative restrictions following complex spine surgery include:

  • No bending, lifting, twisting, pulling, or pushing anything greater than 10 pounds (BLT restrictions) until cleared by your surgeon.
  • No submersion of your incision in a tub bath or swimming for 6 weeks after surgery, showers only.
  • Keep your wound/incision clean and dry by gently washing the incision with mild soap and water and patting the incision dry.
  • We recommend that you maintain adequate protein, fiber, fruits, vegetables and fluid intake, as this will help to speed up your healing.
  • Continue to ambulate at least three times daily and begin light activities as tolerated.

Additional Resources