Original ArticleBenefits of the Enhanced Recovery After Surgery Program in Short-Segment Posterior Lumbar Interbody Fusion Surgery
Introduction
Henri Kehlet first proposed the concept of enhanced recovery after surgery (ERAS) in 1997.1,2 ERAS is a multidisciplinary approach based on evidence-based medical evidence that accelerates recovery by enhancing perioperative care to reduce physical and psychological stress. It was initially used in elderly patients undergoing colon surgery and has since been widely used in other surgical fields, whereas applications in spine surgery have yet to be developed.3 Recently, a study confirmed that the ERAS program could bring many benefits to patients who underwent short-segment lumbar fusion.4,5
It is difficult to develop a uniform, standardized ERAS pathway for spinal fusion surgery because of its heterogeneity. Therefore, different ERAS protocols might be suitable for different lumbar fusion procedures. At present, there are many studies on the application of ERAS in minimally invasive lumbar fusion because it has many advantages, such as causing fewer iatrogenic injuries, shorter hospital stays, and faster postoperative recovery, which are highly consistent with the original concept of ERAS.6, 7, 8 In addition, these studies have demonstrated that perioperative application of ERAS in minimally invasive lumbar fusion surgery can shorten the length of hospital stay, reduce postoperative complications, and improve patient satisfaction.2,9,10
Currently, because of the high equipment requirements and long learning curve associated with minimally invasive spinal fusion surgery, traditional posterior lumbar interbody fusion (PLIF) surgery is still used in most regions to treat lumbar diseases. Therefore, it is of high clinical significance to confirm the effectiveness of ERAS in traditional PLIF surgery. The aim of our study was to demonstrate whether our ERAS program is appropriate for traditional PLIF surgery and what benefits it may bring to patients undergoing short-segment lumbar fusion.
Section snippets
Study Design
Prospective data gathered by our hospital were retrospectively analyzed. The data contained the records of all patients who underwent spinal fusion in 2016 and 2019. All the data came from the hospital’s electronic medical record.
We selected two 1-year periods: the first from before the establishment of the multidisciplinary ERAS team in January 2017 (pre-ERAS year 2016) and the second period when the ERAS was applied widely in our hospital (post-ERAS year 2019). Data were collected from the
Baseline Characteristics
A total of 207 patients were included in our study, 95 of whom were in the pre-ERAS group and 112 of whom were in the ERAS group. All patients were diagnosed with lumbar disc herniation, lumbar stenosis, or spondylolisthesis and underwent a short-level (1- or 2-level) PLIF. The demographic characteristics of the population are shown in Table 2. There was no significant difference between the pre-ERAS group and the ERAS group in age, gender, comorbidities diagnosis, and the number of levels
The Importance of the ERAS Protocol
Patients who are about to undergo surgery suffer from multiple factors such as the disease itself, surgical injury, psychological, and physical stress. ERAS was originally outlined to speed up bed turnover and reduce complications and hospital costs. Although originally designed primarily for colorectal surgery patients, its basic principles have been applied to other surgical disciplines. These basic principles included: 1) shift from a disease-centered approach to a patient-centered approach;
Conclusions
Overall, a traditional open short-segment PLIF with an ERAS protocol performed better in reducing LOS, off-bed time, bleeding, complications, postoperative drainage volume, postoperative pain, drainage tube, and catheter removal time. Importantly, patients were more satisfied with ERAS management than with conventional care. Taken together, we established that a traditional open short-segment PLIF combined with ERAS might bring about more benefits to patients.
CRediT authorship contribution statement
Jinlei Chen: Conceptualization, Methodology, Writing – original draft. Dongliang Li: Conceptualization, Data curation. Ruirui Wang: Conceptualization, Sources. Shuang Wang: Software, Validation, Data curation, Writing – review & editing. Zhizhong Shang: Conceptualization, Methodology. Mingchuan Wang: Conceptualization, Data curation. Xin Wang: Writing – review & editing, Supervision, Project administration, Conceptualization.
Acknowledgments
The authors thank all investigators and supporters involved in this study. Especially, they would like to thank Professor Jinhui Tian (Evidence-Based Medicine Centre, School of Basic Medical Sciences, Lanzhou University, Lanzhou City 730000, China) for their valuable suggestions and inputs during the entire project.
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Conflict of interest statement: This work was supported by Gansu Natural Science Foundation (No. 21JR7RA362), the China Postdoctoral Science Foundation (No. 2017M613342), Lanzhou Chengguan Science and Technology Bureau (No. 2017SHFZ0036), Gansu Natural Science Foundation (No. 18JR3RA353), and the First Hospital of Lanzhou University Foundation (No. ldyyyn2017-26).
Availability of data and material: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.