Benefits of early recovery after surgery (ERAS) protocols on perioperative outcomes in patients undergoing elective lumbar spinal fusion: a prospective study.

BACKGROUND CONTEXT: Enhanced Recovery After Surgery (ERAS) protocols have been shown to accelerate patient recovery across various surgical fields. There are growing reports of the benefits of ERAS for lumbar fusion, but the majority rely on retrospective analysis.

PURPOSE: This study aimed to prospectively assess the impact of an ERAS protocol on perioperative outcomes in patients undergoing lumbar spinal fusion.

STUDY DESIGN/

SETTING

Prospective comparative cohort study conducted at a tertiary medical center in Taipei, Taiwan, between November 2020 and May 2023.

PATIENT SAMPLE: The study included 242 patients undergoing lumbar spinal fusion for degenerative spinal conditions divided into ERAS and non-ERAS groups.

OUTCOME MEASURES: Main outcomes measured included operative duration, estimated blood loss (EBL), postoperative nausea and vomiting (PONV), analgesic use, and visual analog scale (VAS) pain score.

METHODS

Propensity score matching (PSM) was used to minimize confounders between the 2 groups. Differences between the 2 groups were assessed using the 2-sample independent t-test or nonparametric Mann-Whitney U test for continuous variables, and the chi-square test or Fisher's exact test for categorical variables.

RESULTS

The ERAS group had significantly shorter operative time (202±68 min vs 255±85 min) and EBL (480±302 ml vs 641±387 ml) compared to the non-ERAS group. The ERAS group had significantly less total morphine-sulfate-equivalent (MSE) consumption (27±24 mg vs 42±42 mg) and used patient-controlled analgesia (PCA) (97% vs 41%) more frequently compared to the non-ERAS group. Notably, the ERAS group had a shorter time to ambulation and shorter time to removal of Foley catheters.

CONCLUSIONS

These data suggest that the employed ERAS protocol significantly enhances recovery trajectories and the need for analgesics in patients undergoing lumbar spinal fusion.