Enhanced recovery after surgery (ERAS) protocol in spine surgery

Bansal, Tungish; Sharan, Alok; Garg, Bhavuk

doi:10.1016/j.jcot.2022.101944

Cited by 26 publications

(22 citation statements)

References 83 publications

(102 reference statements)

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“…ERAS protocols have emerged as a standardized approach to enhance perioperative outcomes in major surgeries. 2,8,9 This study aims to further our understanding of ERAS implementation in spine surgery, specifically in patients undergoing corrective surgery for adult cervical deformity. Three groups were stratified based on the timing of ERAS interventions.…”

Section: Discussionmentioning

confidence: 99%

“…Adjusting for staged versus same-day procedures, compared with early patients, intermediate and late patients demonstrated significantly lower hospital LOS (11.90 vs 4.46 vs 4.33 d, P = 0.027), and were cohorts demonstrated significantly decreasing rates of surgical intensive care unit admission (47.90% vs 30.30% vs 25.30%, P < 0.001). Postoperatively, discharge disposition differed significantly between cohorts, with late patients more likely to be discharged to home versus early or intermediate cohorts [χ 2 (2) = 37.973, P < 0.001]. Adjusting for BL disability mJOA and EQ5D, by the 6week postoperative mark, later cohorts demonstrated significantly greater improvements in both EQ5D scores (0.4745 vs 0.5991 vs 0.8269, P = 0.004) and EQ5D-VAS scores (64.38 vs 68.33 vs 87.00, P = 0.047).…”

Section: Perioperative Differencesmentioning

confidence: 99%

“…ERAS protocols have undergone a remarkable evolution over the years, progressing from an initial focus on analgesia to encompass a comprehensive array of strategies aimed at optimizing patient outcomes across various surgical disciplines. 2 While early ERAS initiatives primarily emphasized effective pain management strategies to mitigate postoperative discomfort, contemporary protocols have expanded far beyond pain control. The integration of early ambulation with physical therapy has also emerged as a pivotal component, recognizing the benefits of mobilization in reducing the risk of complications and accelerating recovery.…”

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confidence: 99%

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The Evolution of Enhanced Recovery After Surgery

Passias,

Tretiakov,

Onafowokan

et al. 2024

Clinical Spine Surgery

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Study Design: Retrospective cohort. Objective: To investigate the impact of evolving Enhanced Recovery After Surgery (ERAS) protocols on outcomes after cervical deformity (CD) surgery. Background: ERAS can help accelerate patient recovery and assist hospitals in maximizing the incentives of bundled payment models while maintaining high-quality patient care. However, there remains a paucity of literature assessing how developments have impacted outcomes after adult CD surgery. Methods: Patients with operative CD 18 years or older with pre-baseline and 2 years (2Y) postoperative data, who underwent ERAS protocols, were stratified by increasing implantation of ERAS components: (1) early (multimodal pain program), (2) intermediate (early protocol + paraspinal blocks, early ambulation), and (3) late (early/intermediate protocols + comprehensive prehabilitation). Differences in demographics, clinical outcomes, radiographic alignment targets, perioperative factors, and complication rates were assessed through Bonferroni-adjusted means comparison analysis. Results: A total of 131 patients were included (59.4 ± 11.7 y, 45% females, 28.8 ± 6.0 kg/m2). Of these patients, 38.9% were considered “early,” 36.6% were “intermediate,” and 24.4% were “late.” Perioperatively, rates of intraoperative complications were lower in the late group (P= 0.036). Postoperatively, discharge disposition differed significantly between cohorts, with late patients more likely to be discharged to home versus early or intermediate cohorts [χ2(2) = 37.973, P< 0.001]. In terms of postoperative disability recovery, intermediate and late patients demonstrated incrementally improved 6 W modified Japanese Orthopedic Association scores (P= 0.004), and late patients maintained significantly higher mean Euro-QOL 5-Dimension Questionnaire and modified Japanese Orthopedic Association scores by 1 year (P< 0.001, P= 0.026). By 2Y, cohorts demonstrated incrementally increasing SWAL-QOL scores (all domains P< 0.028) domain scores versus early or intermediate cohorts. By 2Y, incrementally decreasing reoperation was observed in early versus intermediate versus late cohorts (P= 0.034). Conclusions: The present study demonstrates that patients enrolled in an evolving ERAS program demonstrate incremental improvement in preoperative optimization and candidate selection, greater likelihood of discharge to home, decreased postoperative disability and dysphasia burden, and decreased likelihood of intraoperative complications and reoperation rates.

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Section: Discussionmentioning

confidence: 99%

Section: Perioperative Differencesmentioning

confidence: 99%

mentioning

confidence: 99%

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The Evolution of Enhanced Recovery After Surgery

Passias,

Tretiakov,

Onafowokan

et al. 2024

Clinical Spine Surgery

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“…The copyright holder for this preprint this version posted April 10, 2023. ; https://doi.org/10.1101/2023.04.08.23288328 doi: medRxiv preprint with long operating times, risk of neurological complications, and bleeding. In previous studies showing a rapid return to normalcy in patients after scoliosis surgery using the ERAS pathway versus the traditional pathway, the results showed a significant reduction in operative time and bleeding in the ERAS group [24][25]. Gornitzky et al [26] found a significant decrease in pain scores on POD 0, 1, and 2 and a decrease in opioid analgesic use on POD 0 through the ERAS pathway.…”

Section: (Which Was Not Certified By Peer Review)mentioning

confidence: 95%

The Comparison of enhanced recovery after surgery versus traditional pathway in early-onset scoliosis surgery

Jian

Cui

et al. 2023

Preprint

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The optimized enhanced recovery after surgery (ERAS) pathway in patients with early onset scoliosis (EOS) has not yet been comprehensively described. This study explored the efficacy and feasibility of an integral process of the ERAS pathway in posterior spinal fusion (PSF) surgery in EOS patients. A total of 70 patients were included in this study, with 35 patients receiving treatment using an ERAS pathway designed and implemented by a multidisciplinary team. The remaining 35 patients followed the traditional pathway (TP) perioperative care. Patient demographics, radiographic parameters, surgical data, and clinical information were collected and analyzed retrospectively. There were no significant differences in sex, height, weight, age, body mass index, preoperative hemoglobin level, fusion segments, number of screws, Cobb angle of the main curve, or surgical duration between the ERAS and TP groups. Regarding pain intensity, the estimated blood loss (EBL), first ambulation time, length of analgesic use, postoperative length of stay (LOS), drainage duration, drainage volume, and incidence of blood transfusion were significantly lower in the ERAS group than in the TP group. The ERAS pathway in EOS orthopedic surgery effectively reduces intraoperative bleeding, alleviates postoperative pain, reduces com-plications, accelerates recovery, and shortens hospital stays. Therefore, spinal surgeons should adopt the ERAS pathway in EOS surgery.

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“…Early studies on ERAS were performed in patients undergoing colorectal surgery. With the ERAS concept being recognized by most surgeons, it is now used in many different surgical specialties (4).…”

Section: Introductionmentioning

confidence: 99%