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

Abstract

Background context Fast-track is an evidence-based multidisciplinary strategy for pre-, intra-, and postoperative management of patients during major surgery. To date, fast-track has not been recognized or accepted in all surgical areas, particularly in orthopedic spine surgery where it still represents a relatively new paradigm. Purpose The aim of this review was provided an evidenced-based assessment of specific interventions, measurement, and associated outcomes linked to enhanced recovery pathways in spine surgery field. Methods We conducted a systematic review in three databases from February 2012 to August 2022 to assess the pre-, intra-, and postoperative key elements and the clinical evidence of fast-track protocols as well as specific interventions and associated outcomes, in patients undergoing to spine surgery. Results We included 57 full-text articles of which most were retrospective. Most common fast-track elements included patient’s education, multimodal analgesia, thrombo- and antibiotic prophylaxis, tranexamic acid use, urinary catheter and drainage removal within 24 hours after surgery, and early mobilization and nutrition. All studies demonstrated that these interventions were able to reduce patients’ length of stay (LOS) and opioid use. Comparative studies between fast-track and non-fast-track protocols also showed improved pain scores without increasing complication or readmission rates, thus improving patient’s satisfaction and functional recovery. Conclusions According to the review results, fast-track seems to be a successful tool to reduce LOS, accelerate return of function, minimize postoperative pain, and save costs in spine surgery. However, current studies are mainly on degenerative spine diseases and largely restricted to retrospective studies with non-randomized data, thus multicenter randomized trials comparing fast-track outcomes and implementation are mandatory to confirm its benefit in spine surgery.

What’s New in Spine Surgery

“…These programs focus on early mobilization and decreasing surgery-associated stress, with the aim of shortening the length of hospital stay 18 . Contartese et al conducted a systematic review to assess key preoperative, intraoperative, and postoperative elements and clinical evidence regarding fast-track protocols in patients undergoing spine surgery 19 . In a review of 57 mostly retrospective articles, common fast-track elements, including patient education, multimodal analgesia, thromboprophylaxis and antibiotic prophylaxis, tranexamic acid use, urinary catheter and drain removal within 24 hours, early mobilization, and appropriate nutrition, reduced patients’ length of stay and opioid use.…”