Impact of Compliance with an Enhanced Recovery After Surgery Program on the Outcomes Among Elderly Patients Undergoing Lumbar Fusion Surgery

Abstract

Background and Aim The benefits of the enhanced recovery after surgery (ERAS) program to elderly patients have not been evaluated in lumbar fusion surgery. Compliance with the ERAS program is associated with prognosis. There is currently no adequate assessment about the importance of the individual components of ERAS program in lumbar fusion surgery. The aim of the study was to analyze the effect of compliance with our ERAS program and the relative importance of the individual ERAS program components among elderly patients undergoing lumbar fusion surgery. Methods A retrospective case-review study was conducted from March 2018 to March 2020. The ERAS program for lumbar fusion surgery at our department was implemented. Overall compliance was found to be 92.9%, and this was used as a cutoff for dividing patients into higher compliance and lower compliance groups. Patient characteristics and clinical outcomes were compared between groups. Results The overall compliance rate was 92.9%, distributing 91 patients into the higher compliance group and 169 patients into the lower compliance group. Patients with higher compliance were younger (p=0.045). The length of stay (LOS) of patients with higher compliance was significantly shorter than that of patients with lower compliance. Patients with higher compliance had significantly fewer complications (p=0.031). A multivariate analysis showed that surgical time (p=0.029), lower compliance (p=0.034), and early oral feeding (p=0.026) were predictors of any postoperative complications. On multivariate analysis, the following items remained correlated with prolonged LOS (LOS≥12 days): older age (p=0.010), lower compliance (p<0.0001), early ambulation (p=0.018), and stick to discharge criteria (p=0.040). Conclusion Low compliance with ERAS program among elderly patients undergoing lumbar fusion surgery was associated with a higher incidence of complications and prolonged LOS. The failure of early oral feeding was associated with increased complications, and the failure of early ambulation or sticking to discharge criteria was significantly more influential on prolonged LOS.

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

“…Nevertheless, the implementation of the ERAS protocol in orthopedic practice remains a difficult issue [ 7 ]. Recently, a number of studies on ERAS have reported various obstacles in ERAS implementation, such as reduced compliance and ERAS protocol deviation by providers and patients [ 8 , 9 ]. To transfer the ERAS protocol to be practiced successfully, practical strategies based on a sufficient understanding of ERAS components and their outcomes are necessary.…”

Patients Older Than 75 Years Undergoing Polysegmental Lumbar Fusion Surgery Can also Benefit from Enhanced Recovery After Surgery Program

“…In an effort to improve our perioperative care, ERAS was considered in January 2018 and implemented in January 2019. 16 To increase the reliability of the data, we selected two periods, pre-ERAS (from January to December, 2017, n = 54) and ERAS (from January to December, 2020, n = 46) and the ERAS group was treated with standard ERAS items while the pre-ERAS group was performed with no unified guidelines. We enrolled patients over 75 years of age, diagnosed with lumbar disc herniation or lumbar spinal stenosis and underwent polysegement fusion surgery, defined as more than two fusion levels.…”

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

“…And all of these patients strictly followed the same discharge criteria published by our department previously: no clinical complications; visual analog scales < 3 with oral analgesics; independent ambulation or ambulation with minimal assistance; absence of fever in the last 48 hours. 14 The collected preoperative clinical data included age, sex, body mass index (BMI), smoking status, concomitant diseases, American Society of Anesthesiologists (ASA) grade, preoperative albumin, and hemoglobin levels, operation time, anesthesia time, estimated blood loss (EBL), and need for allogenic transfusion. Postoperative complications (nausea and vomiting, electrolyte imbalance, urinary retention, deep venous thrombosis, postoperative hypoproteinemia, surgical site infection, and myocardial ischemia), LOS, urinary catheter extraction time, and mobilization time were also extracted.…”