TY - JOUR
T1 - Enhanced recovery after surgery trends in adult spine surgery
T2 - A systematic review
AU - Tong, Yixuan
AU - Fernandez, Laviel
AU - Bendo, John A.
AU - Spivak, Jeffrey M.
N1 - Publisher Copyright:
© International Society for the Advancement of Spine Surgery
PY - 2020
Y1 - 2020
N2 - Background: Enhanced Recovery After Surgery (ERAS) is a multimodal, multidisciplinary approach to optimizing the postsurgical recovery process through preoperative, perioperative, and postoperative interventions. ERAS protocols are emerging quickly within orthopedic spine surgery, yet there is a lack of consensus on optimal ERAS practices. Objective: The aim of this systematic review is to identify and discuss the trends in spine ERAS protocols and the associated outcomes. Methods: A literature search on PubMed was conducted to identify clinical studies that implemented ERAS protocols for various spine procedures in the adult population. The search included English-language literature published through December 2019. Additional sources were retrieved from the reference lists of key studies. Studies that met inclusion criteria were identified manually. Data regarding the study population, study design, spine procedures, ERAS interventions, and associated outcome metrics were extracted from each study that met inclusion criteria. Results: Of the 106 studies identified from the literature search, 22 studies met inclusion criteria. From the ERAS protocols in these studies, common preoperative elements include patient education and modified preoperative nutrition regimens. Perioperative elements include multimodal analgesia and minimally invasive surgery. Postoperative elements include multimodal pain management and early mobilization/rehabilitation/nutrition regimens. Outcomes from ERAS implementation include significant reductions in length of stay, cost, and opioid consumption. Although these trends were observed, there remained great variability among the ERAS protocols, as well as in the reported outcomes. Conclusions: ERAS may improve cost-effectiveness to varying degrees for spinal procedures. Specifically, the use of multimodal analgesia may reduce overall opioid consumption. However, the benefits of ERAS likely will vary based on the specific procedure. Clinical Relevance: This review contributes to the assessment of ERAS protocol implementation in the field of adult spine surgery.
AB - Background: Enhanced Recovery After Surgery (ERAS) is a multimodal, multidisciplinary approach to optimizing the postsurgical recovery process through preoperative, perioperative, and postoperative interventions. ERAS protocols are emerging quickly within orthopedic spine surgery, yet there is a lack of consensus on optimal ERAS practices. Objective: The aim of this systematic review is to identify and discuss the trends in spine ERAS protocols and the associated outcomes. Methods: A literature search on PubMed was conducted to identify clinical studies that implemented ERAS protocols for various spine procedures in the adult population. The search included English-language literature published through December 2019. Additional sources were retrieved from the reference lists of key studies. Studies that met inclusion criteria were identified manually. Data regarding the study population, study design, spine procedures, ERAS interventions, and associated outcome metrics were extracted from each study that met inclusion criteria. Results: Of the 106 studies identified from the literature search, 22 studies met inclusion criteria. From the ERAS protocols in these studies, common preoperative elements include patient education and modified preoperative nutrition regimens. Perioperative elements include multimodal analgesia and minimally invasive surgery. Postoperative elements include multimodal pain management and early mobilization/rehabilitation/nutrition regimens. Outcomes from ERAS implementation include significant reductions in length of stay, cost, and opioid consumption. Although these trends were observed, there remained great variability among the ERAS protocols, as well as in the reported outcomes. Conclusions: ERAS may improve cost-effectiveness to varying degrees for spinal procedures. Specifically, the use of multimodal analgesia may reduce overall opioid consumption. However, the benefits of ERAS likely will vary based on the specific procedure. Clinical Relevance: This review contributes to the assessment of ERAS protocol implementation in the field of adult spine surgery.
KW - ERAS
KW - Enhanced Recovery After Surgery
KW - Fast-track surgery
KW - Multimodal analgesia
KW - Orthopedics
KW - Rapid recovery program
KW - Spine surgery
UR - https://www.scopus.com/pages/publications/85090940030
U2 - 10.14444/7083
DO - 10.14444/7083
M3 - Review article
AN - SCOPUS:85090940030
SN - 2211-4599
VL - 14
SP - 623
EP - 640
JO - International Journal of Spine Surgery
JF - International Journal of Spine Surgery
IS - 4
ER -