Benefits of the Enhanced Recovery After Surgery Program in Short-Segment Posterior Lumbar Interbody Fusion Surgery

Jinlei Chen; Dongliang Li; Ruirui Wang; Shuang Wang; Zhizhong Shang; Mingchuan Wang; Xin Wang

doi:10.1016/j.wneu.2021.12.046

Benefits of the Enhanced Recovery After Surgery Program in Short-Segment Posterior Lumbar Interbody Fusion Surgery

World Neurosurg. 2022 Mar:159:e303-e310. doi: 10.1016/j.wneu.2021.12.046. Epub 2021 Dec 18.

Authors

Jinlei Chen¹, Dongliang Li¹, Ruirui Wang¹, Shuang Wang², Zhizhong Shang¹, Mingchuan Wang¹, Xin Wang³

Affiliations

¹ First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China.
² School of Public Health, Lanzhou University, Lanzhou, Gansu, China.
³ First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China; Department of Spine, Changzheng Hospital, Naval Medical University, Shanghai, China; Chengren Institute of Traditional Chinese Medicine, Gansu Province, China. Electronic address: wangxinldyy@126.com.

PMID: 34929368
DOI: 10.1016/j.wneu.2021.12.046

Abstract

Objective: Enhanced recovery after surgery (ERAS) is a multimodal, evidence-based approach to perioperative care that aims to reduce physiological and psychological stress, improve the quality of rehabilitation, and speed up the recovery of patients. Our study aims to investigate the benefits of perioperative use of ERAS for a short-segment posterior lumbar interbody fusion.

Methods: We selected two 1-year periods: the first from before the establishment of the multidisciplinary ERAS team in January 2017 (pre-ERAS year 2016) and the second period when ERAS was applied widely in our hospital (ERAS year 2019). Data were collected from the electronic medical records of patients who had undergone a short-level posterior lumbar interbody fusion during these 2 periods. The primary outcomes were postoperative complications, length of hospital stay, and off-bed time.

Results: A total of 207 patients were included; 95 patients in the pre-ERAS group were compared with 112 patients in the ERAS group. There was no significant difference between the 2 groups in baseline demographic. Patients in the ERAS group had significantly shorter length of hospital stay, off-bed time, and earlier drainage tube and catheter removal time. The rate of postoperative complications differed significantly between the pre-ERAS and ERAS groups. Patients in the ERAS group had significantly less intraoperative blood loss, financial cost, and opioid consumption than patients in the pre-ERAS group. The visual analog scale and Oswestry Disability Index scores, similar at baseline, were significantly lower in the ERAS group at postoperative day 3.

Conclusions: The benefits of our ERAS protocol for patients undergoing short-level posterior lumbar fusion are evident in terms of reduced hospital stay and time to get out of bed, reduced incidence of postoperative complications, intraoperative blood loss, opioid use and hospital costs, and improved early postoperative pain and dysfunction.

Keywords: ERAS; Enhanced recovery after surgery; Lumbar fusion surgery; Posterior lumbar interbody fusion (PLIF).

MeSH terms

Analgesics, Opioid
Blood Loss, Surgical / prevention & control
Enhanced Recovery After Surgery*
Humans
Lumbar Vertebrae / surgery
Postoperative Complications / epidemiology
Postoperative Complications / prevention & control
Retrospective Studies
Spinal Fusion* / methods
Treatment Outcome

Substances

Analgesics, Opioid