Enhanced recovery after spine surgery: review of the literature

Corniola, Marco Vincenzo; Debono, Bertrand; Joswig, Holger; Lemée, Jean‐Michel; Tessitore, Enrico

doi:10.3171/2019.1.focus18657

Cited by 55 publications

(62 citation statements)

References 35 publications

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“…ERAS protocols were first developed in colorectal surgery and have since been applied in a wide range of surgical specialties [10]. In spine surgery, ERAS has been shown to reduce acute care costs, length of hospital stay, and postoperative pain [9,12-14]. The rationale of ERAS lies within the fact that its elements aim to (1) improve the preoperative state of the patient, (2) reduce the burden of surgery, and (3) stimulate fast recovery to ADL.…”

Section: Discussionmentioning

confidence: 99%

“…Although there have been quite a few studies published on ALIF for CLBP, there is still a shortage of data regarding the safety of short-stay and outpatient ALIF procedures [9]. Enhanced recovery after surgery (ERAS) protocols [10] have also only been scarcely applied to ALIF [11-12]. Questions may be asked on outcomes and complication rates of carrying out such procedures in these settings [9].…”

Section: Introductionmentioning

confidence: 99%

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Safety and Efficacy of Anterior Lumbar Interbody Fusion for Discogenic Chronic Low Back Pain in a Short-stay Setting: Data From a Prospective Registry

Vieli¹,

Staartjes²,

Eversdjik³

et al. 2019

Cureus

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IntroductionAs a possible treatment option for chronic lower back pain (CLBP) due to single-level degenerative disc disorder (DDD), the efficacy of anterior lumbar interbody fusion (ALIF) has been reviewed various times in the existing literature. Nevertheless, a scarcity of data exists pertaining to ALIF procedures carried out in a short-stay setting using an Enhanced Recovery after Surgery (ERAS) protocol, particularly concerning the safety.MethodsProspectively collected data are analyzed to study the efficacy and safety of short-stay ERAS ALIF in treatment of single-level DDD. Visual Analog Scale (VAS) in both back and leg pain along with the Oswestry Disability Index (ODI) were used to collect measure outcomes. The primary endpoint was a minimum clinically important difference (MCID) of ≥30% for the ODI at 12 months.ResultsForty-four patients underwent surgery after failed long-term conservative treatment. MCID was achieved in 78%. Age was the only significant factor in association with MCID (p = 0.03), while gender, Modic changes, results of prognostic tests, prior surgery and smoking status had no significant influence on either MCID or change scores for any outcome measure. One complication in the form of transient new radiculopathy occurred in one patient (2.3%).ConclusionWith overall positive outcomes in terms of both efficacy and safety, an ALIF procedure with subsequent implementation of an ERAS protocol in a short-stay setting can be an option for strictly selected patients with CLBP. Further study, however, possibly with a larger sample size, would be necessary to substantiate these findings.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Safety and Efficacy of Anterior Lumbar Interbody Fusion for Discogenic Chronic Low Back Pain in a Short-stay Setting: Data From a Prospective Registry

Vieli¹,

Staartjes²,

Eversdjik³

et al. 2019

Cureus

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“…The authors performed this process by reviewing the current externally validated enhanced recovery protocols as recommended by the ERAS Society. We compared and contrasted the current published guidelines and reviews for gastrointestinal surgery, thoracic surgery, orthopedic surgery, and gynecological surgery [3][4][5][6][7][8]12]. We identified and applied the relevant components to the field of spinal surgery.…”

Section: Methodsmentioning

confidence: 99%

“…We identified and applied the relevant components to the field of spinal surgery. In addition, we compared and contrasted the technical elements present in the published prior reviews on enhanced recovery in spinal surgery [8,11,12]. A brief summary of this process has been provided in Additional file 1.…”

Section: Methodsmentioning

confidence: 99%

“…The 2019 ERAS protocol for thoracic surgery considered perioperative analgesia and minimally invasive surgery critical components of the pathway [3]. For the enhanced recovery in spinal surgery, previous systematic reviews of proposed interventions have been published [8,11,12]. The critical components of the pathway in spinal surgery are considered to be the provision of comprehensive perioperative nutrition, multimodal analgesia, minimally invasive surgery where clinically feasible, and early mobilization [11].…”

Section: Description Of the Pathwaymentioning

confidence: 99%

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Proposed pathway for patients undergoing enhanced recovery after spinal surgery: protocol for a systematic review

et al. 2020

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Background: The best evidence-enhanced recovery care pathway is yet to be defined for patients undergoing spinal surgery. Minimally invasive surgery, multimodal analgesia, early mobilization, and early postoperative nutrition have been considered as critical components of enhanced recovery in spinal surgery (ERSS). The objective of this study will be to synthesize the evidence underpinning individual components of a proposed multidisciplinary enhanced recovery pathway for patients undergoing spinal surgery. Methods: This is the study protocol for a systematic review of complex interventions. Our team identified 22 individual care components of a proposed pathway based on clinical practice guidelines and published reviews. We will include systematic reviews and meta-analysis, randomized controlled trials, non-randomized controlled trials, and observational studies in adults or pediatric patients evaluating any one of the pre-determined care components. Our primary outcomes will be all-cause mortality, morbidity outcomes (e.g., pulmonary, cardiac, renal, surgical complications), patient-reported outcomes and experiences (e.g., pain, quality of care experience), and health services outcomes (e.g., length of stay and costs). We will search the following databases (1990 onwards) MEDLINE, EMBASE, and Cochrane Library (Cochrane Database of Systematic Reviews and CENTRAL). Two reviewers will independently screen all citations, full-text articles, and abstract data. Potential conflicts will be resolved through discussion. The risk of bias for individual studies will be appraised using appropriate tools. A narrative synthesis will be provided with the information presented in the text and tables to summarize and explain the characteristics and findings of the included studies. Due to clinical and methodological heterogeneity, we do not anticipate to conduct meta-analyses. Confidence in cumulative evidence for each component of care will be classified according to the GRADE system.Discussion: This systematic review will identify, evaluate, and integrate the evidence underpinning individual components of a pathway for patients undergoing spinal surgery. The formation of an evidence-based pathway will allow for the standardization of clinical care delivery within the context of enhanced recovery in spinal surgery. Systematic review registration: PROSPERO CRD42019135289

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