Impact of enhanced recovery after surgery (ERAS) protocols in elderly patients undergoing lumbar fusion: a systematic review with meta-analysis and trial sequential analysis.

PURPOSE: Lumbar spinal fusion (LSF) represents a primary surgical approach for treating degenerative lumbar diseases and spinal instability in elderly patients. However, the impact of ERAS protocols in elderly patients undergoing LSF remains unknown. This article aims to summarize the effectiveness and safety of ERAS protocols in elderly patients undergoing LSF, thereby providing evidence-based guidance for perioperative management of this population.

METHODS

A search was performed across multiple databases, including PubMed, Embase, Cochrane Library, Web of Science, Preprint Platforms (MedRxiv), and Clinical Trial database, to identify eligible studies. Retrospective studies and randomized controlled trials that compared the clinical utility of ERAS with conventional pathways in elderly patients (≥ 65years) undergoing LSF were included. The retrieved literature underwent Meta-analysis R software. Trial sequential analyses were conducted for outcomes reported in at least five studies, using the Trial Sequential Analysis Software.

RESULTS

The meta-analysis incorporated seventeen eligible studies. Compared with conventional perioperative care, ERAS protocols showed significant benefits across multiple outcomes: reduced length of stay(LOS) (mean difference: -2.29 days; 95%CI: -2.84 to -1.74; I² = 72.7%), decreased intraoperative blood loss (mean difference: -46.2 mL; 95%CI: -73.44 to -19.00; I² = 72.1%), and earlier ambulation (mean difference: -1.53 days; 95% CI: -2.300 to -0.753; I² = 91.7%). The protocol also significantly lowered risks of postoperative complications (OR = 0.44; 95%CI: 0.364 to 0.528; I² = 0%), postoperative nausea and vomiting(PONV) (OR = 0.50; 95%CI: 0.340 to 0.747; I² = 0%), and hospital readmission (OR = 0.66; 95%CI: 0.471 to 0.936; I² = 2.8%).

CONCLUSION

The application of the ERAS protocol in elderly patients undergoing LSF was associated with favorable clinical outcomes, including shorter LOS, lower incidence of postoperative complications, reduced risk of PONV, and decreased readmission rates.