Enhanced recovery after surgery (ERAS) protocol reduces LOS without additional adverse events in spine surgery

Ramos-Pascual, Sonia; Fière, Vincent; Dupasquier, Maud; Vieira, Thaïs Dutra; Szadkowski, Marc

doi:10.1016/j.otsr.2020.01.017

Cited by 33 publications

(25 citation statements)

References 25 publications

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“…Additionally, a trend toward the lower rate of urinary tract infection in ERAS group was observed(p=0.07), although there was no statistical signi cance, the potential association may be detected in a long-term studies with larger sample sizes. Moreover, the implement of ERAS pathway did not increase the risk of cardiovascular complications, acute cerebral infarction and local haematoma, which were consistent with previous studies on ERAS pathway [23,24].…”

Section: Disscusionsupporting

confidence: 91%

Enhanced Recovery After Surgery Pathway: Association with Lower Incidence of Wound Complications and Severe Hypoalbuminemia in Patients Undergoing Posterior Lumbar Fusion Surgery

Wang

et al. 2021

Preprint

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Background. Wound complications were associated with worse satisfaction and additional costs in patients underwent posterior lumbar fusion(PLF) surgery ,the relationship between enhanced recovery after surgery(ERAS)pathway and wound complications remains poorly characterized.Methods. In this retrospective single-center study, we compared 530 patients receiving ERAS pathway care with previous 530 patients in non-ERAS group. The primary aim of our study was to identify the relationship between ERAS program and the incidence of postoperative wound related complications and other complications following PLF surgery, other outcomes included the length of stay(LOS), 90-day hospital and rehabilitation center readmission.Results. Average patient age was 65yr. There were more patients with old cerebral infarction in ERAS group (p<0.01), other demographics and comorbidities were similar between both groups. Patients in ERAS group had a lower incidence of postoperative wound-related complications compared with non-ERAS group(12.4 vs 17.8%, p=0.02).The non-ERAS group had a significantly higher rate of wound dehiscence or poor wound healing(6% vs 3%, p=0.02). ERAS group had a lower incidence of server postoperative hypoalbuminemia(serum albumin less than 30g/L)(15.8% vs 9.0% p<0.01).Additionally, ERAS patients had a shorter postoperative LOS (8.0±1.5 vs 9.5±1.7 p<0.01), lower rate of readmission within 90 days (1.9% vs 6.4%, p<0.01) and discharge to rehabilitation center (4.2% vs 1.0%, p<0.01).Conclusion. ERAS pathway may help to decrease the rates of postoperative wound complications and server hypoalbuminemia following PLF surgery, additionally, we demonstrated that ERAS pathway was also associated with shorter LOS and lower rate of readmissions within 90-day.

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Section: Disscusionsupporting

confidence: 91%

Enhanced Recovery After Surgery Pathway: Association with Lower Incidence of Wound Complications and Severe Hypoalbuminemia in Patients Undergoing Posterior Lumbar Fusion Surgery

Wang

et al. 2021

Preprint

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“…indicating that compared with non-obese patients, obese patients with ALDH may accept PELD without signi cant di culties. We believe that because PELD caused less surgical trauma and required no wound drainage tubes, it can effectively shorten the postoperative bedridden recovery time, reduce the occurrence of bed-related complications and hospitalization costs, improve postoperative quality of life, and help patients return to their normal life or work faster, which is in line with the current concept of enhanced recovery after surgery in the eld of spinal surgery [33]. However, this was contrary to the results reported in some studies that microdiscectomy or open surgery increased the amount of intraoperative blood loss and length of hospitalization in obese adults [7,34], indicating that PELD was advantageous in the treatment of obese patients with LDH from the other side.…”

Section: Discussionsupporting

confidence: 60%

Evaluation of percutaneous endoscopic lumbar discectomy in treatment of obese adolescents with lumbar disc herniation：A retrospective study

Zhu

Liu

2021

Preprint

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Background: Obese patients are at risk of complications such as poor wound healing and increased infection rates after spinal surgery. Percutaneous endoscopic lumbar discectomy (PELD) has advantages over conventional open surgery in the treatment of obese adult patients with lumbar disc herniation (LDH) because it can decrease perioperative complications and enhance satisfaction degrees of patients. However, no clinical studies have evaluated the efficacy of PELD in obese adolescents with LDH. This study aimed to evaluate the efficacy of PELD in the treatment of obese ALDH.Methods: We retrospectively collected clinical data from 208 patients with single-segment ALDH who underwent PELD treatment in our hospital between January 2015 and December 2019. According to the body mass index classification standard of obesity for adolescents in our country, the patients were divided into obese and non-obese groups (control group). Based on the preoperative baseline data of the two groups, propensity score matching was performed to select patients from the two groups for the comparative study. Perioperative data included operative time, intraoperative blood loss and length of postoperative hospitalization. The visual analog scale (VAS), Oswestry disability index (ODI) and modified MacNab criteria were recorded as the main indicators of the surgical outcome, and the recurrence rate and incidence of complications were recorded as the minor indicators. Results: The obese and control groups included 45 patients each after 1:1 propensity score matching. Both groups showed improvements in VAS and ODI scores after surgery and at each follow-up time point (p < 0.05). However, there was no significant statistical difference in VAS and ODI scores between the two groups at each follow-up time point (p >0.05). In addition, the differences in operative time, intraoperative blood loss, length of postoperative hospitalization, incidence of complications, and recurrence rate were not statistically significant between the two groups (p >0.05). At the final follow-up, there was no significant difference in the excellent and good rate of MacNab classification between the two groups (p >0.05). Conclusion: PELD is a safe and effective minimally invasive technique for the treatment of obese patients with ALDH. The efficacy of PELD in obese and non-obese patients with ALDH was comparable.

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“…showed no significant difference between BMI, smokers, old ages, DM patients in ERAS program [46]. So, patients are encouraged for earlier ambulation.…”

Section: Other Relative Factorsmentioning

confidence: 87%

Risk Factor of Postoperative Lumbar Surgical Site Infection: A Literature Review

Chang¹,

Sah²,

Zhang³

et al. 2021

OJO

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Nowadays there have been various advanced techniques to overcome disparate types of lumbar degenerative diseases. However, post-operation complications such as Surgical Site Infection (SSI) still give the surgeon with a big challenge. This article is going to study the risk factor that causes the lumbar SSI by reviewing all the articles that can be assessed through PubMed, websites of science and other internet data base. Numerous articles have stated different reported prevalence rates of 0.7% to 16% for surgical site infection. This article will document the most common and significant risk factors for SSI. At last, we suggest that there should be preoperative patient screening and postoperative internal environment maintenance, this will be the best way to reduce postoperative SSI rate or prevent SSI from happening.

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Enhanced recovery after surgery (ERAS) protocol reduces LOS without additional adverse events in spine surgery

Cited by 33 publications

References 25 publications

Enhanced Recovery After Surgery Pathway: Association with Lower Incidence of Wound Complications and Severe Hypoalbuminemia in Patients Undergoing Posterior Lumbar Fusion Surgery

Enhanced Recovery After Surgery Pathway: Association with Lower Incidence of Wound Complications and Severe Hypoalbuminemia in Patients Undergoing Posterior Lumbar Fusion Surgery

Evaluation of percutaneous endoscopic lumbar discectomy in treatment of obese adolescents with lumbar disc herniation：A retrospective study

Risk Factor of Postoperative Lumbar Surgical Site Infection: A Literature Review

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