Application of enhanced recovery after surgery for patients with spinal metastasis: a systematic review and meta-analysis.

BACKGROUND AND

OBJECTIVE

Enhanced Recovery After Surgery (ERAS) has been used to improve recovery and outcomes after surgical operations. However, the literature on implementing the ERAS concept in spine metastasis is sparse. This systematic review and meta-analysis sought to shed light on this topic. METHOD: MEDLINE, PubMed, and Embase were searched. The primary outcomes were hospital LOS and complications. The secondary outcomes were duration of operation, operative blood loss, postoperative visual analogue scale (VAS) and morphine equivalent daily dose (MEDD), time to ambulation, time to urinary catheter removal, regular diet, radiation, and systemic internal therapy.

RESULTS

Included four studies yielded 975 patients, from which 442 and 533 patients underwent surgery with and without ERAS, respectively. The two groups were similar in age, male gender, comorbidities, smoking, Eastern Cooperative Oncology Group (ECOG) Performance Status score, location of surgery, and source of primary cancers. In the ERAS group, hospital length of stay (LOS MD= -1.97 days [-3.07, -0.87], p = 0.005) was shorter; however, both groups were similar in complications (OR = 0.71 [0.27, 1.82], p = 0.470). Furthermore, operative blood loss (MD= -204.35 ml [-400.66, -8.03], p = 0.04), third-day postoperative VAS score (MD= -0.95 [-1.48, -0.41], p = 0.005), postoperative MEDD (MD= -206.81 mg [-319.62, -94.01], p = 0.003), time to ambulation (MD= -33.81 h [-43.91, -23.71], p < 0.001), time to urinary catheter removal (MD= -30.75 h [-33.99, -27.50], p < 0.001), time to regular diet (MD= -19.67 h [-32.62, -6.72], p = 0.003), time to radiation (MD= -6.05 days [-6.87, -5.24], p < 0.001), and time to systemic internal therapy (MD= -4.96 days [-5.79, -4.13], p < 0.001) were lower in the ERAS group. In addition, duration of operation was similar (MD = 0.06 min [-34.45, 34.57], p = 1).

CONCLUSION

This study showed that the application of ERAS for patients with spinal metastases is beneficial in terms of operative blood loss, pain management, and time metric values. The possible effect of ERAS protocols on perioperative complications deserves further investigation. We recommend considering the ERAS concept for patients with spinal metastases.