# Impact of Enhanced Recovery After Surgery with Neuromuscular Monitoring and Sugammadex on Healthcare Costs and Effectiveness of Recovery in Patients Following Anterior Cervical Spine Discectomy

## TL;DR

This study shows that using a specific recovery protocol with neuromuscular monitoring and sugammadex after cervical spine surgery reduces hospital stays, costs, and recovery time without increasing complications.

## Contribution

The novel contribution is confirming the effectiveness of ERAS with neuromuscular monitoring and sugammadex specifically for anterior cervical spine surgery.

## Key findings

- ERAS reduced hospital length of stay by 0.62 days and costs by NTD 13,174.40.
- Recovery metrics like ventilator time and ambulation time improved significantly.
- No increase in complications was observed in the ERAS group.

## Abstract

Background/Objectives: Anterior cervical spine surgery (ACSS) is an effective surgical procedure used to treat degenerative cervical spine disease. Enhanced recovery after surgery (ERAS) is a new and promising paradigm for ACSS. The purpose of this study is to investigate the role of neuromuscular monitoring with sugammadex in the ERAS protocol, which had not been confirmed in ACSS. Methods: In this retrospective study, the electronic medical records of patients aged 20 to 80 years who had undergone first-time ACSS performed in the period from 1 December 2018 to 31 December 2023 were reviewed. Patients were divided into ERAS and non-ERAS groups. Inverse probability of treatment weighting (IPTW) was used to balance differences between the groups. Statistical analyses were conducted using SPSS 20, including independent samples t-tests, chi-square tests, linear regression, and logistic regression. Results: A total of 394 patients were included in this study: 163 in the non-ERAS group and 231 in the ERAS group. In the ERAS group, significant reductions were observed in several key outcomes compared with the non-ERAS group: LOS was reduced by 0.62 days (p < 0.001), hospital costs were lowered by NTD 13,174.40 (p < 0.001), ventilator time was decreased by 149.40 min (p < 0.001), time to first oral intake was shortened by 4.71 h (p < 0.001), and time to first ambulation was reduced by 8.00 h (p < 0.001). No significant differences in complication rates were observed between the two groups. Conclusions: The ACSS-tailored ERAS pathway with NMM and sugammadex can reduce LOS, cost, and speed of patient recovery without increasing complications.