Enhanced recovery after surgery (ERAS) for open transforaminal lumbar interbody fusion: a retrospective propensity-matched cohort study

Porche, Ken; Samra, Ronny; Melnick, Kaitlyn; Brennan, Meghan; Vaziri, Sasha; Seubert, Christoph N.; Polifka, Adam; Hoh, Daniel J.; Mohamed, Basma

doi:10.1016/j.spinee.2021.10.007

Cited by 31 publications

(22 citation statements)

References 37 publications

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“…ERAS is an evidence-based multidisciplinary perioperative pathway designed to achieve early convalescence, a reduction of LOS, and postoperative complications ( 5 , 21 , 22 ). Conspicuous perioperative outcomes in previous studies resulted in ERAS gaining in popularity in spine surgery.…”

Section: Discussionmentioning

confidence: 99%

Comparison of perioperative outcomes in frail patients following multilevel lumbar fusion surgery with and without the implementation of the enhanced recovery after surgery protocol

Cui

Wang²,

Wang³

et al. 2022

Front. Surg.

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BackgroundEnhanced recovery after surgery (ERAS) is an evidence-based multimodal perioperative management designed to reduce the length of stay (LOS) and complications. The purpose of the present study is to evaluate the recovery of physiological function, LOS, complications, pain score, and clinical efficacy in frail elderly patients undergoing multisegment fusion surgery after the implementation of the ERAS protocol.MethodsFrail patients older than 75 years undergoing multilevel lumbar fusion surgery for degenerative discogenic conditions, lumbar spinal stenosis, and lumbar spondylolisthesis from January 2017 to December 2018 (non-ERAS frail group) and from January 2020 to December 2021 (ERAS frail group) were enrolled in the present study. Propensity score matching for age, sex, body mass index, and smoking status was performed to keep comparable characteristics between the two groups. Further recovery of physiological function, LOS, complications, pain score, and clinical efficacy were compared between the groups.ResultsThere were 64 pairs of well-balanced patients, and the clinical baseline data were comparable between the two groups. There was significant improvement in terms of recovery of physiological function (10.65 ± 3.51 days vs. 8.31 ± 3.98 days, p = 0.011) and LOS (12.18 ± 4.69 days vs. 10.44 ± 4.60 days, p = 0.035), while no statistical discrepancy was observed with regard to complications between the groups, which indicated favorable outcomes after the implementation of the ERAS protocol. Further analysis indicated that more patients were meeting a minimally clinical important difference for the visual analog score for the legs and the Oswestry Disability Index in the ERAS frail group. With regard to postoperative pain, the score was higher in the ERAS frail group than in the non-ERAS frail group on postoperative day (POD) 1 (4.88 ± 1.90 in the ERAS frail group vs. 4.27 ± 1.42 in the non-ERAS frail group, p = 0.042), while there was no significant discrepancy on POD 2 (3.77 ± 0.88 in the ERAS frail group vs. 3.64 ± 1.07 in the non-ERAS frail group, p = 0.470) and POD 3 (3.83 ± 1.89 in the ERAS frail group vs. 3.47 ± 1.75 in the non-ERAS frail group, p = 0.266).ConclusionsIn this retrospective cohort study, we found a significant improvement in terms of LOS, recovery of physiological function, and clinical efficacy after the implementation of the ERAS protocol in elderly and frail patients undergoing multilevel lumbar fusion surgery, while there was no significant discrepancy with regard to complications, 90-day readmission, and postoperative pain.

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Section: Discussionmentioning

confidence: 99%

Comparison of perioperative outcomes in frail patients following multilevel lumbar fusion surgery with and without the implementation of the enhanced recovery after surgery protocol

Cui

Wang²,

Wang³

et al. 2022

Front. Surg.

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“…Substantial attention has been paid to the effects of compliance with ERAS and the reduction of LOS. [17][18][19] To our knowledge, few studies are focusing on the risk factors associated with prolonged LOS in short-level lumbar fusion surgery despite the implementation of ERAS protocol.…”

Section: Discussionmentioning

confidence: 99%

“…Substantial attention has been paid to the effects of compliance with ERAS and the reduction of LOS. 17-19 To our knowledge, few studies are focusing on the risk factors associated with prolonged LOS in short-level lumbar fusion surgery despite the implementation of ERAS protocol. In our study, we found that age ≥ 75 years, female sex, ASA ≥ 3, operation time, anesthesia time, delayed postoperative ambulation, prolonged removal of urinary catheter, Clavien-Dindo grade >1 and allogeneic transfusion were associated with prolonged LOS.…”

Section: Discussionmentioning

confidence: 99%

The Potential Risk Factors for Prolonged Length of Stay Despite an Enhanced Recovery After Surgery Protocol for Elderly Patients Undergoing Short-Level Lumbar Fusion Surgery

Cui

Kong

Wang

et al. 2022

Geriatr Orthop Surg Rehabil

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Objective To identify the risk factors associated with prolonged length of stay (LOS) despite an enhanced recovery after surgery (ERAS) protocol in short-level lumbar fusion surgery. Methods We gathered data for all patients undergoing short-level lumbar fusion surgery from January to November 2021. Given the discharge criteria, a threshold was set according to mean LOS, and two groups were spontaneously formed: LOS shorter than the threshold for discharge (control group, n = 114) and LOS longer or equal to the threshold for discharge (delayed group, n = 72). Preoperative metrics were compared to identify risk factors associated with prolonged LOS. Results A total consecutive 186 patients with complete medical records were enrolled (77 males and 109 females; mean age 71.08 ± 5.70 years). After dichotomization according to the threshold for discharge, there were 114 patients in control group and 72 in delayed group. Statistical analysis demonstrated that age ≥75 years ( P = .002), female sex ( P < .001), American Society of Anesthesiologists grade ≥ 3 ( P = .035), operation time ( P < .001), anesthesia time ( P < .001), ambulation time >1 day ( P = .027), removal of urinary catheter time >1 day ( P = .019), fusion levels ( P < .001), Clavien-Dindo grade > 1 ( P <.001) and allogeneic transfusion ( P = .009) were significantly related to prolonged LOS. Binary logistic regression revealed that age (odds ratio (OR) 5.149; 95% confidence interval (CI) 2.045-12.966, P = .001), sex (OR 5.185, 95% CI 2.183-12.317, P < .001) and Clavien-Dindo grade > 1(OR 15.936, 95% CI 5.220-48.652, P < .001) were independent risk factors of prolonged LOS. Conclusions In this retrospective study, we analyzed the potential risk factors associated with delayed LOS despite implementing ERAS, further, binary logistic regression exhibited that age ≥75 years old, female sex and Clavien-Dindo grade >1 were independently correlated with prolonged LOS.

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“…ERAS nursing measures are mainly divided into three aspects: preoperative, intraoperative, and postoperative, which can be presented as follows: (1) patient's education, (2) shortened preoperative fasting, (3) preoperative antibiotics, (4) standard anesthesia regimen, (5) multimodal analgesia, (6) early oral feeding (7) early ambulation, (8) early removal of bladder catheter, (9) antithrombotic prophylaxis, (10) maintenance of patient's body temperature, (11) improvement of the sleep quality of patients, and (12) monitoring of vital signs (Table 2).…”

Section: Eras Interventionsmentioning

confidence: 99%

“…Enhanced recovery after surgery (ERAS) is a nursing concept on the basis of evidence-based medicine, which aims to improve the prognosis of patients, reduce the length of hospital stay (LHS), and optimize patient satisfaction. It has been widely used in several surgical elds, and has exhibited a satisfactory effect [5][6][7]. In addition, previous studies have also proved its application in lumbar surgery.…”

Section: Introductionmentioning

confidence: 99%

A new nursing pattern based on ERAS concept for patients with lumbar degenerative diseases treated with OLIF surgery: A retrospective study

Yang

et al. 2022

Preprint

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Objective The purpose of this study was to introduce enhanced recovery after surgery (ERAS) concept into patients with lumbar degenerative diseases who were treated with oblique lumbar interbody fusion (OLIF), and to assess whether it could increase clinical efficacy, reduce perioperative complications, shorten length of hospital stay (LHS), decrease readmission rate, and improve patient satisfaction. Methods The study included patients with lumbar degenerative diseases (LDDs) who underwent OLIF between July 2017 and October 2018 (non-ERAS group), and between November 2018 and July 2020 (ERAS group) at the Spine Surgery Department of the Third Hospital of Hebei Medical University. The two groups were compared according to the demographic and clinical characteristics. Results There was no significant difference in descriptive characteristics and concomitant diseases between the two groups. The preoperative Oswestry disability index (ODI) score (P = 0.191), lumbar visual analogue scale (VAS) score (P = 0.470), and leg VAS score (P = 0.657) did not significantly different. Most of the ERAS measures were also well implemented after surgery, except for early delivery (74.2%), early catheter removal (63.9%), and multimodal analgesia (80.6%). The LHS in the ERAS group was significantly shorter than that in the non-ERAS group (P = 0.004). Besides, Hamilton Anxiety Rating Scale (HAMA) score at 3 days after surgery showed a significant difference between the two groups (P = 0.019). The patient satisfaction in ERAS group was significantly higher than that in the non-ERAS group (P = 0.001). Conclusion The new nursing pattern combined with ERAS in patients with LDDs who underwent OLIF did not improve the short-term prognosis of surgery, while it could effectively reduce postoperative complications, shorten the LHS, and improve patient satisfaction, and did not lead to additional adverse events.

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Enhanced recovery after surgery (ERAS) for open transforaminal lumbar interbody fusion: a retrospective propensity-matched cohort study

Cited by 31 publications

References 37 publications

Comparison of perioperative outcomes in frail patients following multilevel lumbar fusion surgery with and without the implementation of the enhanced recovery after surgery protocol

Comparison of perioperative outcomes in frail patients following multilevel lumbar fusion surgery with and without the implementation of the enhanced recovery after surgery protocol

The Potential Risk Factors for Prolonged Length of Stay Despite an Enhanced Recovery After Surgery Protocol for Elderly Patients Undergoing Short-Level Lumbar Fusion Surgery

A new nursing pattern based on ERAS concept for patients with lumbar degenerative diseases treated with OLIF surgery: A retrospective study

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