Enhanced Recovery After Surgery Protocol in Minimally Invasive Lumbar Fusion Surgery Reduces Length of Hospital Stay and Inpatient Narcotic Use

Model-Based Computational Analysis on the Effectiveness of Enhanced Recovery after Surgery in the Operating Room with Nursing

“…In the ERAS pathway, a return visit was made to correctly evaluate the patients’ pain after the operation. It is beneficial for wound healing and will speed up recovery if analgesia is given in a preventive, timely, and multimode manner ( 26 ). ERAS has been shown to allow patients to move out of bed sooner ( 27 , 28 ) and reduce the length of stay in hospital ( 29 , 30 ).…”

Fast-track protocols for patients undergoing spine surgery: a systematic review

“…In our quality assessment for spine surgery the 44% [ 15 , 23 , 27 , 29 , 32 – 38 , 40 – 42 , 46 – 49 , 51 , 55 , 56 , 61 , 67 , 68 , 70 ] of the studies were rated strong, 25% [ 17 , 18 , 21 , 22 , 25 , 28 , 31 , 39 , 43 , 44 , 60 , 62 , 63 , 65 ] were rated moderate, and 32% [ 16 , 19 , 20 , 24 , 26 , 30 , 45 , 50 , 52 – 54 , 57 – 59 , 64 , 66 , 69 , 71 ] were rated weak. Methodological weaknesses that led to moderate or weak quality scores often included the lack of a sample size justification, power description, or variance and effect estimates, the lack of subjects selected or recruited from the same population, the lack of results evaluation more than once over in time, the lack of blinded assessor and the lack of measurement of potential confounding variables.…”

“…=levels fused, Hb level, pain score, complications Young et al 2021 [ 63 ] Retrospective 243 patients: -Fast-track group ( n = 97, mean age 62 ± 14, 49 females); −Non-fast-track group ( n = 146, mean age 59 ± 13, 66 females) Yes ACDF, PCDF, lumbar decompression, posterior lumbar fusion, lumbar microdiscectomy 1, 2, 3, 4, 5+ NR NR 51 ± 30 h 3 incidental durotomy, 2 surgical site infection 1 instrumentation misplacement requiring operative revision, 1 disc herniation requiring reoperation 30 days ↓Opioid use at day 1 (26 ± 33 vs. 42 ± 409 MMEs) and in opiate-naive patients (16 ± 21 vs. 38 ± 36 MMEs), LOS (51 ± 30 vs. 62 ± 49 h) in fast-track group vs. non-fast-track group. =complications, 30 days readmission, 30 days reoperation time operation Band et al 2022 [ 64 ] Prospective 32 patients: -Fast-track group (n = 16); −Non-fast-track group ( n = 16) Yes Single-level MIS-TLIF for degenerative disease NR diabetes, hypertension NR 1.6 days NR NR NR ↓LOS (1.6 vs. 2.4 days), opioid consumption (51 mg MME vs. 320 mg MME) in fast-track group vs. non-fast-track group Chen et al 2022 [ 65 ] Retrospective 207 patients: -Fast-track group ( n = 112, mean age 52.86 ± 11.55, 49% females); −Non-fast-track group (n = 95, mean age 54.77 ± 11.66, 60% females) Yes Short-level (1- or 2-level) primary open PLIF for lumbar disc herniation, lumbar stenosis, and spondylolisthesis NR NR NR 10.44 ± 3.07 Urinary retention (3.57%), constipation (10.71%), nausea and vomiting (5.36%), wound infection, venous thrombosis, fever, urinary tract infection, paravertebral hematoma, delirium 30-day readmission rate (4.46%), 30-day reoperation rate (2.68%) 30 days ↓LOS (10.44 ± 3.07 vs. 15.29 ± 3.57 days), off-bed time (7.53 ± 2.80 vs. 13.82 ± 3.44 days), complications (28.57% vs. 42.11%), urinary retention (3.57% vs. 11.58%), constipation (10.71% vs. 22.11%), nausea and vomiting (5.36% vs. 13.68%), drainage tube removal time (2 ± 0.65 vs. 3.53 ± 0.63), catheter removal time (1.79 ± 0.68 vs. 3.97 ± 1.15), surgical drainage at day 1–3 (165.20 ± 40.85 vs. 351.31 ± 32.49), intraoperative blood loss (126.61 ± 34.49 vs. 145.24 ± 22.52), financial cost (57,905.94 ± 12,463.50 vs. 62,683.68 ± 12,583.34 yuan), opioid consumption (18.98 ± 11.40 vs. 36.89 ± 15.30 mg), VAS score at day 3 (2.67 ± 1.02,vs. 3.51 ± 0.88), ODI score at day 3 (37.43 ± 10.22 vs. 41.19 ± 8.29), and ↑satisfaction (89.29% vs. 77.89%) in fast...…”

“…Cardiac and pulmonary function, nutritional status, mental health consultations Preconditioning exercise (6 weeks before surgery), balloon blowing NR NR Antibiotic prophylaxis (within 0.5-1 h of incision and additional antibiotic if operation time > 180 min), fasting (clear fluids up to 2 h and solids up to 6 h before anesthesia, carbohydrate-contained beverage or high-dose glucose infusion ≥5 mg/kg/min) General anesthesia (IV propofol 1–2 mg/kg, midazolam 1–2 mg, sufentanil 0.3–0.6 mg/kg, rocuronium 0.6 mg/kg), multimodal analgesia IV (parecoxib 40 mg, oxycodone 0.1–0.2 mg/kg within 0.5 h of induction, remifentanil 0.1–0.3 mg/kg/min, dexmedetomidine 0.4 mg/kg/h, propofol 4-12 mg/kg/h, opioids, COX-2) inhibitor), subcutaneous drainage Restricted fluid therapy, temperature management (36 °C, fluid warming, airway humidification, forced-air warming blanket), antipressure ulcers nursing (foam pads), blood management (hypotensive anesthesia with arterial pressure 70-75 mmHg, cell salvage, TXA 10-20 mg/kg before incision + 1 mg/kg/h infusion + 3 g topical application, blood products transfusion if Hb < 70 g/L) Dual antiemetic prophylactic therapy with IV ondansetron 4 mg, dexamethasone 10 mg, or intramuscularly metoclopramide 10 mg Young et al 2021 [ 63 ] General informations and no smoking. Chlorhexidine for skin, screening for diabetes mellitus, malnutrition and methicillin- Staphylococcus aureus colonization, neuropsychology clinic, multidisciplinary anesthesia pain management Yes Standard bowel regimen, diet NR Analgesia (1 g acetaminophen, 600-1200 mg gabapentin 60 min before surgery), infection prophylaxis (2 g cefazolin or clindamycin/vancomycin 30-60 min before incision) Local anesthetic (bupivacaine, and epidural morphine sulfate in nonfusion cases), catheter NR 10 mg dexamethasone Band et al 2022 [ 64 ] Optimization of chronic disease management (diabetes, hypertension), discussion regarding weight loss, no smocking, preoperative education, counseling, and hospital orientation session NR NR Oral analgesics (acetaminophen 1 g, baclofen 10 mg, oxycontin 20 mg, gabapentin 300 mg) NR General anesthesia (midazolam, ketamine 0.5 mg/kg bolus up to max of 50 mg followed by 0.5 mg/kg/h, and/or dexmedetomidine infusion 0.4mcg/kg/h), dexamethasone 10 mg), subfascial drains, peri-incisional bupivacaine 0.5% 20Ml, urinary catheters NR Zofran 4 mg Chen et al 2022 [ 65 ] Education, assessment, diet management, smoking and alcohol cessation, psychological evaluation NR Fasting (6 h for liquids and 8 h for solid food), clear fluids, including carbohydrate drinks up to 2 h before Oral celecoxib 200 mg and pregabalin 150 mg within 1 h before surgery IV first-generation cephalosporin for 30 min before …”

“…Chlorhexidine for skin, screening for diabetes mellitus, malnutrition and methicillin- Staphylococcus aureus colonization, neuropsychology clinic, multidisciplinary anesthesia pain management Yes Standard bowel regimen, diet NR Analgesia (1 g acetaminophen, 600-1200 mg gabapentin 60 min before surgery), infection prophylaxis (2 g cefazolin or clindamycin/vancomycin 30-60 min before incision) Local anesthetic (bupivacaine, and epidural morphine sulfate in nonfusion cases), catheter NR 10 mg dexamethasone Band et al 2022 [ 64 ] Optimization of chronic disease management (diabetes, hypertension), discussion regarding weight loss, no smocking, preoperative education, counseling, and hospital orientation session NR NR Oral analgesics (acetaminophen 1 g, baclofen 10 mg, oxycontin 20 mg, gabapentin 300 mg) NR General anesthesia (midazolam, ketamine 0.5 mg/kg bolus up to max of 50 mg followed by 0.5 mg/kg/h, and/or dexmedetomidine infusion 0.4mcg/kg/h), dexamethasone 10 mg), subfascial drains, peri-incisional bupivacaine 0.5% 20Ml, urinary catheters NR Zofran 4 mg Chen et al 2022 [ 65 ] Education, assessment, diet management, smoking and alcohol cessation, psychological evaluation NR Fasting (6 h for liquids and 8 h for solid food), clear fluids, including carbohydrate drinks up to 2 h before Oral celecoxib 200 mg and pregabalin 150 mg within 1 h before surgery IV first-generation cephalosporin for 30 min before Local anesthesia, long-acting opioids, anesthetic agents, and large doses of muscle relaxants avoided Normothermia (heating device, 36 °C), goal-directed fluid administration, IV tranexamic acid (10-20 mg/kg load dose before resection followed by infusion at 1 mg/kg/h maintenance dose) NR Leng et al 2022 [ 66 ] Education, consultation, smoking cessation NR Modern fasting (solids within 6 h and carbohydrate beverages within 2 h prior) Oral celecoxib 200 mg, pregabalin 75 mg, acetaminophen 1 g, 1 h before Antimicrobial prophylaxis (cefuroxime 1.5 g, 30 min before) Anesthesia, local analgesia (5 mg/mL ropivacaine hydrochloride), catheter TXA (1 g bolus followed by 0.5 g/h infusion), dexamethasone 10 mg, normovolemia (goal-directed fuid administration, vasopressors), normothermia (36 °C, convective warming device) 5-HT receptor antagonist (ramosetron) Porche et al b2022 [ 67 ] Physical capacity, cognitive, cardiac, pulmonary, renal, pain, nutrition and risk evaluation, anemia and diabetes control, education, medical optimization, smoking cessation …”