Enhanced Recovery after Surgery (ERAS) and its applicability for major spine surgery

This article examines the relevance of applying the Enhanced Recovery after Surgery (ERAS) approach to patients undergoing major spinal surgery. The history of ERAS, details of the components of the approach, and the underlying rationale are explained. Evidence on outcomes achieved by using the ERAS approach in other orthopaedic and complex surgical procedures are then outlined. Data on major spinal surgery rates and current practice are reviewed and the rationale for the use of ERAS in major spinal surgery is discussed, and potential challenges to its adoption acknowledged. A thorough literature search is then undertaken to examine the use of ERAS pathways in major spinal surgery, and the results presented. The article then reviews the evidence to support the application of individual ERAS components such as patient education, multimodal pain management, surgical approach, blood loss, nutrition, and physiotherapy in major spinal surgery, and discusses the need for further robust research to be undertaken. The article concludes that given the rising costs of surgery and levels of patient dissatisfaction, an ERAS pathway that focuses on optimizing clinical procedures by adopting evidence-based practice, and improving logistics, should enable major spinal surgery patients to recover more quickly with lower rates of morbidity and improved longer term outcomes

STOCK OWNERSHIP AND CONGRESSIONAL ELECTIONS: THE POLITICAL ECONOMY OF THE MUTUAL FUND REVOLUTION

"We find that higher stock ownership rates are linked to an upward shift in the Republican share of the House popular vote since the late 1980s, consistent with theories that property interests affect voting. To proxy for discontinuous stock ownership rates, we use equity mutual fund costs, which have fallen, are negatively correlated with stock ownership rates and the Republican vote share in the long run, and help explain short-run changes along with midterm elections, economic conditions, and presidential popularity. Findings suggest that the major parties' shares of the House popular vote will fluctuate around 50% until other factors trigger a political realignment. "("JEL "D72, G11) Copyright (c) 2007 Western Economic Association International.