Postoperative applications of the fast track technology in patients with herniated intervertebral discs of the lumbosacral spine

Nazarenko, A G; Konovalov, N A; Krutko, Aleksandr; Zamiro, T N; Героева, И. Б.; Gubaydullin, R R; Хорева, Н. Е.; Комаров, А Н; Stepanyan, M A; Konstantinova, M. V.; Казачонок, А. М.; Onoprienko, R A; Korolishin, V A; Кубынина, Т. Н.; Martynova, M A

doi:10.17116/neiro20168045-12

Cited by 17 publications

(16 citation statements)

References 11 publications

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“…8-15, 19, 28-31,33 Reasons for exclusion were being abstracts only (n = 19), failing to present primary data (n = 12), describing results in a pediatric population (n = 7), failing to describe the ERAS protocol (n = 1), and lacking full-text English-language translation (n = 1). Of the included studies, 1 article was level II evidence, 7 while the remainder were level III [8][9][10][11][12][13][14][15][16]19,[27][28][29][30][31][32][33] (n = 17) or level IV 17,18,[20][21][22][23][24][25][26] (n = 9) evidence. Nine studies described ERAS protocols applied to all elective spine patients, 8,[17][18][19][27][28][29][30][31] 2 described protocols for cervical spine surgery patients, 21,32 14 described lumbar-specific surgery protocols, 9-15, 20, 22-26,33 and 2 described protocols for patients undergoing spine tumor surgery.…”

Section: Resultsmentioning

confidence: 99%

“…Fourteen studies 9-15, 20, 22-26,33 were identified that used lumbar spine-specific protocols, describing a total of 970 patients treated with 13 distinct protocols (Table 3). In the described protocols, the most commonly included elements were patient education (8 studies); 10,14,15,[22][23][24][25][26] preoperative carbohydrate loading (6 studies); 10,14,[23][24][25][26] multimodal, opioid-sparing analgesia during the intraoperative or postoperative period (11 studies); 9-11, 13-15, 23-26,33 goal-directed fluid replacement intraoperatively (4 studies); 10,14,25,26 local analgesia with an amino-amide sodium channel blocker (e.g., bupivacaine and ropivacaine) (9 studies); 10,12,14,15,20,[23][24][25][26] use of minimally invasive surgery (MIS) techniques (4 studies); 10,23,24,33 urinary catheter avoidance or discontinuation within 48 hours of placement (8 studies); 9,10, 13, 20, 23-26 perioperative antiemetic prophylaxis (4 studies); 13,15,25,26 early resumption of enteral feeding (9 studies); 10,11,13,14,[23]…”

Section: Eras Protocols For Lumbar Spine Surgerymentioning

confidence: 99%

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Systematic review and meta-analysis of the clinical utility of Enhanced Recovery After Surgery pathways in adult spine surgery

Pennington¹,

Cottrill²,

Lubelski³

et al. 2021

Journal of Neurosurgery: Spine

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OBJECTIVESpine surgery has been identified as a significant source of healthcare expenditures in the United States. Prolonged hospitalization has been cited as one source of increased spending, and there has been drive from providers and payors alike to decrease inpatient stays. One strategy currently being explored is the use of Enhanced Recovery After Surgery (ERAS) protocols. Here, the authors review the literature on adult spine ERAS protocols, focusing on clinical benefits and cost reductions. They also conducted a quantitative meta-analysis examining the following: 1) length of stay (LOS), 2) complication rate, 3) wound infection rate, 4) 30-day readmission rate, and 5) 30-day reoperation rate.METHODSUsing the PRISMA guidelines, a search of the PubMed/Medline, Web of Science, Cochrane Reviews, Embase, CINAHL, and OVID Medline databases was conducted to identify all full-text articles in the English-language literature describing ERAS protocol implementation for adult spine surgery. A quantitative meta-analysis using random-effects modeling was performed for the identified clinical outcomes using studies that directly compared ERAS protocols with conventional care.RESULTSOf 950 articles reviewed, 34 were included in the qualitative analysis and 20 were included in the quantitative analysis. The most common protocol types were general spine surgery protocols and protocols for lumbar spine surgery patients. The most frequently cited benefits of ERAS protocols were shorter LOS (n = 12), lower postoperative pain scores (n = 6), and decreased complication rates (n = 4). The meta-analysis demonstrated shorter LOS for the general spine surgery (mean difference −1.22 days [95% CI −1.98 to −0.47]) and lumbar spine ERAS protocols (−1.53 days [95% CI −2.89 to −0.16]). Neither general nor lumbar spine protocols led to a significant difference in complication rates. Insufficient data existed to perform a meta-analysis of the differences in costs or postoperative narcotic use.CONCLUSIONSPresent data suggest that ERAS protocol implementation may reduce hospitalization time among adult spine surgery patients and may lead to reductions in complication rates when applied to specific populations. To generate high-quality evidence capable of supporting practice guidelines, though, additional controlled trials are necessary to validate these early findings in larger populations.

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Section: Resultsmentioning

confidence: 99%

Section: Eras Protocols For Lumbar Spine Surgerymentioning

confidence: 99%

Systematic review and meta-analysis of the clinical utility of Enhanced Recovery After Surgery pathways in adult spine surgery

Pennington¹,

Cottrill²,

Lubelski³

et al. 2021

Journal of Neurosurgery: Spine

View full text Add to dashboard Cite

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“…The 15 studies involved 9700 participants who received ERAS and 11,143 who received a control intervention. Eleven [ 29 , 32 – 41 ] had data on the incidence of postoperative complication, 6 papers [ 29 , 32 , 35 , 37 , 41 , 42 ] reported 30-day readmission, 7 [ 24 , 32 , 35 , 36 , 39 , 40 , 43 ] referred to 30-day mortality rate, and ODI [ 40 , 44 ] was recorded in 2 papers.…”

Section: Resultsmentioning

confidence: 99%

An enhanced recovery after surgery program in orthopedic surgery: a systematic review and meta-analysis

Chen

et al. 2019

J Orthop Surg Res

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ObjectivesThere is an increased interest in enhanced recovery after surgery (ERAS) minimizing adverse events after orthopedic surgery. Little consensus supports the effectiveness of these interventions. The purpose of present systematic review and meta-analysis is to comprehensively analyze and evaluate the significance of ERAS interventions for postoperative outcomes after orthopedic surgery.MethodsPubMed, EMBASE, and Cochrane databases were totally searched from the inception dates to May 31, 2018. Two reviewers independently extracted the data from the selected articles using a standardized form and assessed the risk of bias. The analysis was performed using STATA 12.0.ResultsA total of 15 published studies fulfilled the requirements of inclusion criteria. We found that the ERAS group showed a significant association with lower incidence of postoperative complications (OR, 0.70; 95% CI, 0.64 to 0.78). Meanwhile, ERAS was also associated with the decline in 30-day mortality rate and Oswestry Disability Index (ODI). However, no significant differences were identified between the two groups regarding the 30-day readmission rate (P = 0.397).ConclusionsOur meta-analysis suggested that the ERAS group had more advantages in reducing incidence of postoperative complications, 30-day mortality rate, and ODI after orthopedic surgery, but not of 30-day readmission rate. However, further research with standardized, unbiased methods and larger sample sizes is required for deeper analysis.Electronic supplementary materialThe online version of this article (10.1186/s13018-019-1116-y) contains supplementary material, which is available to authorized users.

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“…This approach made it possible to significantly reduce the need for opioid analgesics; the duration of inpatient treatment was also reduced by about 1.4 days compared to conventional rigid stabilization [ 4 ]. Nazarenko et al [ 21 ] found that the use of ARP for microdiscectomy reduced the severity of pain in the early postoperative period by 10% and improved the functional recovery by 20% compared to the standard perioperative management of patients with herniated intervertebral discs.…”

Section: Discussionmentioning

confidence: 99%

Accelerated Recovery Program for Patients with Polysegmental Degenerative Lumbar Spine Disease

Kalinin¹,

Goloborodko²,

Shepelev³

et al. 2021

Sovrem Tehnol Med

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The aim of the study was to evaluate the effectiveness of the accelerated recovery program for patients with polysegmental degenerative diseases of the lumbar spine.Materials and Methods. This prospective study included 53 patients who underwent two-level transforaminal interbody fusion in the L II -S I segments. Two groups were identified: in group 1 (n=24), operations were performed using the accelerated recovery program; in group 2 (n=29), open rigid stabilization was used under traditional intravenous anesthesia. The end-point parameters were the number of bed-days spent in the hospital after the operation, the number of perioperative surgical complications and adverse effects of anesthesia, and the number of re-hospitalizations within 90 days. We also recorded the time of patient activation, the level of pain around the operated zone (using a visual analogue scale), and the quality of life in the long-term postoperative period (median 18 months); the latter was assessed using the SF-36 questionnaire (physical and psychological components of health).Results. Patients under the accelerated recovery program were found to have a shorter duration of surgery and anesthesia, less blood loss, lower amounts of injected opioids, faster verticalization, and a reduced period of inpatient treatment (p<0.05 for all parameters). As compared to group 2, patients in group 1 had a lower level of pain in the surgery zone (p<0.05), better long-term indicators of the physical and psychological components of health (p<0.05), a lower number of anesthesia-associated adverse events (p<0.05), and a lower rate of postoperative complications (p<0.05). During the 90-day postoperative observation, four patients of group 2 (13.8%) were urgently referred to a medical institution for additional medical care.Conclusion. The accelerated recovery program for two-level interbody fusion showed its safety and high clinical efficiency in the treatment of patients with polysegmental degenerative diseases of the lumbar spine. The program can be used in any center for spine surgery where effective interaction between polyvalent medical and nursing teams is maintained.

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Postoperative applications of the fast track technology in patients with herniated intervertebral discs of the lumbosacral spine

Cited by 17 publications

References 11 publications

Systematic review and meta-analysis of the clinical utility of Enhanced Recovery After Surgery pathways in adult spine surgery

Systematic review and meta-analysis of the clinical utility of Enhanced Recovery After Surgery pathways in adult spine surgery

An enhanced recovery after surgery program in orthopedic surgery: a systematic review and meta-analysis

Accelerated Recovery Program for Patients with Polysegmental Degenerative Lumbar Spine Disease

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