Enhanced Recovery After Surgery Trends in Adult Spine Surgery: A Systematic Review

Background With increasing interest in enhanced recovery after surgery (ERAS), the literature on ERAS in orthopedic surgery is also rapidly accumulating. This review article aims to (1) summarize the components of the ERAS protocol applied to orthopedic surgery, (2) evaluate the outcomes of ERAS in orthopedic surgery, and (3) suggest practical strategies to implement the ERAS protocol successfully. Main body Overall, 17 components constituting the highly recommended ERAS protocol in orthopedic surgery were identified. In the preadmission period, preadmission counseling and the optimization of medical conditions were identified. In the preoperative period, avoidance of prolonged fasting, multimodal analgesia, and prevention of postoperative nausea and vomiting were identified. During the intraoperative period, anesthetic protocols, prevention of hypothermia, and fluid management, urinary catheterization, antimicrobial prophylaxis, blood conservation, local infiltration analgesia and local nerve block, and surgical factors were identified. In the postoperative period, early oral nutrition, thromboembolism prophylaxis, early mobilization, and discharge planning were identified. ERAS in orthopedic surgery reduced postoperative complications, hospital stay, and cost, and improved the patient outcomes and satisfaction with accelerated recovery. For successful implementation of the ERAS protocol, various strategies including the standardization of care system, multidisciplinary communication and collaboration, ERAS education, and continuous audit system are necessary. Conclusion The ERAS pathway enhanced patient recovery with a shortened length of stay, reduced postoperative complications, and improved patient outcomes and satisfaction. However, despite the significant progress in ERAS implementation in recent years, it has mainly focused on major surgeries such as arthroplasty. Therefore, further efforts to apply, audit, and optimize ERAS in various orthopedic surgeries are necessary.

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“…The ERAS protocol has shown significant cost-effectiveness while reducing the LOS and complications [ 102 , 110 , 115 ]. Garriga et al.…”

Section: Outcomes Of Eras In Orthopedic Surgery (Table 2 ...mentioning

confidence: 99%

Enhanced recovery after surgery for major orthopedic surgery: a narrative review

Choi

Kim

Chang

et al. 2022

Knee Surg & Relat Res

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“…The lack of quantitative evaluation of evidence results in a high variability in interpretations and practices, which hampers the development of an evidencebased ERAS protocol in spine surgery. 15,31 A PROSPECT systematic review on pain management after laminectomy recommended pre-emptive paracetamol and NSAID 2 Summary of the results of network meta-analysis and Grading of Recommendations Assessment, Development and Evaluation (GRADE) certainty of evidence for the regional interventions. Lines in the network graphic represent direct comparisons.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of perioperative pharmacological and regional pain interventions in adult spine surgery: a network meta-analysis and systematic review of randomised controlled trials

Bae

Alboog

Esquivel

et al. 2022

British Journal of Anaesthesia

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Background: Development of a widely accepted standardised analgesic pathway for adult spine surgery has been hampered by the lack of quantitative analysis. We conducted a systematic review and network meta-analysis (NMA) to compare, rank, and grade all pharmacological and regional interventions used in adult spine surgery. Methods: A systematic search was performed in January 2021. We performed double study screening, selection, and data extraction. The co-primary outcomes were cumulative morphine consumption (mg) and visual analogue pain score (range 0e10) at postoperative 24 h. An NMA was performed using the Bayesian approach (random effects model). We also ranked and graded all analgesic interventions using the Grading of Recommendations Assessment, Development and Evaluation approach for NMA. Results: We screened 5908 studies and included 86 randomised controlled studies, which comprised 6284 participants. Of 20 pharmacological and 10 regional interventions, the most effective intervention was triple-drug therapy, consisting of paracetamol, nonsteroidal anti-inflammatory drugs, and adjunct. The pooled mean reduction in morphine consumption and pain score at postoperative 24 h were e26 (95% credible interval [CrI]: e39 to e12) mg and e2.3 (95% CrI: e3.1 to e1.4), respectively. Double-drug therapy was less effective, but showed moderate morphine reduction in a range of e15 to e17 mg and pain score reduction in a range of e1 to e1.6. Single-agent interventions were largely ineffective. Conclusions: Triple-drug therapy is the most effective pain intervention in adult spine surgery with moderate-to-high certainty of evidence. We have also identified a graded analgesic effect, in which analgesic efficacy increased with the number of multimodal drugs used. Systematic review registration: PROSPERO (CRD42020171326).

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“…По данным нашего обзора, в среднем ERAS-программа включала в себя 9 элементов. В спинальной хирургии у взрослых -13-19 элементов [9,34,35]. Дети и взрослые значимо различаются по типу и возможному объему хирургии, что обусловлено анатомофизиологическими особенностями, а также разным коморбидным фоном и возможными функциональными нарушениями.…”

Section: Discussionunclassified

“…Если никаких осложнений не возникает, то пациент мобилизуется и быстро выписывается домой. Однако безопасность должна стоять на первом месте, поэтому выписка в день операции не должна быть определяющим приоритетом в принципах ERAS[9,34,35,68]…”

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Enhanced recovery after surgery in pediatric spine surgery: systematic review

et al. 2021

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Objective. To conduct a systematic review of the literature on the use of enhanced recovery after surgery (ERAS) protocols in spinalsurgery of children and adolescents to determine the existing evidence of the effectiveness of ERAS implementation in clinical practice.Material and Methods. The authors conducted a systematic review of the literature on ERAS in spinal and spinal cord surgery in children and adolescents selected in the databases of medical literature and search resources of PUBMED/MEDLINE, Google Scholar, Cochrane Library and eLibrary according to the PRISMA guidelines and the PICOS inclusion and exclusion criteria.Results. A total of 12 publications containing information on the treatment of 2,145 children, whose average age was 14.0 years (from 7.2 to 16.1), were analyzed. In the reviewed publications, the average number of key elements of the ERAS program was 9 (from 2 to 20), and a total of 23 elements used in spinal surgery in children and adolescents were identified. The most commonly used elements were preoperative education and counseling, prevention of infectious complications and intestinal obstruction, multimodal analgesia, refusal of routine use of drains, nasogastric probes and urinary catheters, standardized anesthesia protocol, early mobilization and enteral loading. The introduction of the ERAS protocol into clinical practice allowed to reduce the complication rate in comparison with the control group by 8.2 %(from 2 to 19 %), the volume of blood loss by 230 ml (from 75 to 427 ml), the operation time by 83 minutes (from 23 to 144 minutes), theduration of hospitalization by 1.5 days (from 0.5 to 3 days) and the total cost of treatment by 2258.5 dollars (from 860 to 5280 dollars).The ERAS program was implemented in pediatric clinics in the USA (75 %), France (8 %) and Canada (17 %).Conclusion. The conducted systematic review of the literature allows us to conclude that the technology of enhanced recovery after surgery is a promising technology that improves surgical outcomes and is applicable in pediatric practice. There is a significant shortage of published studies evaluating the implementation of ERAS in pediatric surgical practice in general, and in spinal surgery in particular, which requires further prospective randomized studies to evaluate ERAS in spinal surgery in children and adolescents.

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Enhanced Recovery After Surgery Trends in Adult Spine Surgery: A Systematic Review

Cited by 60 publications

References 73 publications

Enhanced recovery after surgery for major orthopedic surgery: a narrative review

Enhanced recovery after surgery for major orthopedic surgery: a narrative review

Efficacy of perioperative pharmacological and regional pain interventions in adult spine surgery: a network meta-analysis and systematic review of randomised controlled trials

Enhanced recovery after surgery in pediatric spine surgery: systematic review

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