Nicholas Dietz1, Mayur Sharma2, Shawn Adams2, Ahmad Alhourani2, Beatrice Ugiliweneza2, Dengzhi Wang2, Miriam Nuño3, Doniel Drazin4, Maxwell Boakye5. 1. Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA; Georgetown University School of Medicine, Washington, DC, USA. 2. Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA. 3. Department of Public Health Sciences, Division of Biostatistics, University of California Davis, Davis, California, USA. 4. Pacific Northwest University of Health Sciences College of Medicine, Yakima, Washington, USA. 5. Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA. Electronic address: Maxwell.boakye@ulp.org.
Abstract
BACKGROUND: Enhanced recovery after surgery (ERAS) represents an evidence-based multidisciplinary approach to perioperative management after major surgery that decreases complications and readmissions and improves functional recovery. Spine surgery is a traditionally invasive intervention with an extended recovery phase and may benefit from ERAS protocol integration. METHODS: We analyzed the use of ERAS in spine surgery by completing a search using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and the PICOS (Participants, Intervention, Comparison, Outcomes, Study Design) model through PubMed and Ovid databases to identify studies that fit our search criteria. We assess the outcomes and ERAS elements selected across protocols as well as the study design and internal validation methods. RESULTS: A total of 19 studies met the inclusion criteria and were used in our analysis. Patient populations differed significantly across all 4 studies. Reduction in length of stay was reported in 7 studies using the ERAS protocol. Comparative studies between ERAS and non-ERAS show improved pain scores and reduced opioid consumption postoperatively, but no differences in complications or readmissions between groups. Complication rates under ERAS protocols ranged from 2.0% to 31.7%. Significant pain reduction in visual analog scale scores was observed with 3 ERAS protocols. Direct, indirect, and total cost decreases were also observed with implementation of ERAS protocols. CONCLUSIONS: A limited cohort of studies with significant variability in patient population and ERAS protocol implementation have evaluated the integration of ERAS within spine surgery. ERAS in spine surgery may provide reductions in complications, readmissions, length of stay, and opioid use, in combination with improvements in patient-reported outcomes and functional recovery.
BACKGROUND: Enhanced recovery after surgery (ERAS) represents an evidence-based multidisciplinary approach to perioperative management after major surgery that decreases complications and readmissions and improves functional recovery. Spine surgery is a traditionally invasive intervention with an extended recovery phase and may benefit from ERAS protocol integration. METHODS: We analyzed the use of ERAS in spine surgery by completing a search using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and the PICOS (Participants, Intervention, Comparison, Outcomes, Study Design) model through PubMed and Ovid databases to identify studies that fit our search criteria. We assess the outcomes and ERAS elements selected across protocols as well as the study design and internal validation methods. RESULTS: A total of 19 studies met the inclusion criteria and were used in our analysis. Patient populations differed significantly across all 4 studies. Reduction in length of stay was reported in 7 studies using the ERAS protocol. Comparative studies between ERAS and non-ERAS show improved pain scores and reduced opioid consumption postoperatively, but no differences in complications or readmissions between groups. Complication rates under ERAS protocols ranged from 2.0% to 31.7%. Significant pain reduction in visual analog scale scores was observed with 3 ERAS protocols. Direct, indirect, and total cost decreases were also observed with implementation of ERAS protocols. CONCLUSIONS: A limited cohort of studies with significant variability in patient population and ERAS protocol implementation have evaluated the integration of ERAS within spine surgery. ERAS in spine surgery may provide reductions in complications, readmissions, length of stay, and opioid use, in combination with improvements in patient-reported outcomes and functional recovery.
Authors: Ehsan Jazini; Alexandra E Thomson; Andre D Sabet; Omar Sohail; Leah Y Carreon; Lindsay Orosz; Fenil R Bhatt; Rita Roy; Colin M Haines; Thomas C Schuler; Christopher R Good Journal: Spine Deform Date: 2021-11-06
Authors: A A Kalinin; V Yu Goloborodko; V V Shepelev; Yu Ya Pestryakov; M Yu Biryuchkov; E E Satardinova; V A Byvaltsev Journal: Sovrem Tekhnologii Med Date: 2021-01-01
Authors: Basma Mohamed; Ramani Ramachandran; Ferenc Rabai; Catherine C Price; Adam Polifka; Daniel Hoh; Christoph N Seubert Journal: J Neurosurg Anesthesiol Date: 2021-08-05 Impact factor: 3.956