Implementation enhanced recovery after surgery (ERAS) pathway in patients undergoing surgical treatment for spinal metastases: A multicenter, retrospective, propensity-score matched, cohort study.

PURPOSE: Enhanced recovery after surgery (ERAS) pathway is a multidisciplinary program that aims to improve patient outcomes after various types of surgery. Here, we investigated the effects of the implementation of ERAS pathways on patients with spinal metastases (SM).

METHODS

This was a multicenter, retrospective propensity-score-matched cohort study. We recorded the intraoperative variables, postoperative variables, and complications.

RESULTS

After we performed propensity score matching, we included 60 well-balanced pairs of patients in the study. With respect to intraoperative variables, patients in the ERAS cohort had less fluid intake, shorter postoperative hospital stays, lower postoperative transfusion rates, and limited use of opioids, with statistically significant differences. (P < 0.05) Compared with patients in the non-ERAS cohort, patients in the ERAS cohort had a significantly shorter LOS, lower VAS (POD 1 and 3), less postoperative day 0-5 cumulative opioid use, and less indwelling catheter removal time. They also had a significantly shorter time to ambulation, less bowel movement, and a more regular diet (P < 0.05). With respect to complications, patients in the ERAS cohort exhibited lower postoperative complication rates than patients in the non-ERAS cohort. (P < 0.05)

CONCLUSIONS

The development and implementation of a multidisciplinary, evidence-based, ERAS program specific for patients undergoing surgical treatments for SM led to improvements in clinical quality metrics. Our results can encourage more institutions to promote the implementation of the ERAS pathway for patients with SM.