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Neurosurg Focus. 2019 Apr 1;46(4):E3. doi: 10.3171/2019.1.FOCUS18700.

Enhanced recovery after spine surgery: a systematic review.

Abstract

OBJECTIVEEnhanced recovery after surgery (ERAS) is a multidimensional approach to improving the care of surgical patients using subspecialty- and procedure-specific evidence-based protocols. The literature provides evidence of the benefits of ERAS implementation, which include expedited functional recovery, decreased postoperative morbidity, reduced costs, and improved subjective patient experience. Although extensively examined in other surgical areas, ERAS principles have been applied to spine surgery only in recent years. The authors examine studies investigating the application of ERAS programs to patients undergoing spine surgery.METHODSThe authors conducted a systematic review of the PubMed and MEDLINE databases up to November 20, 2018.RESULTSTwenty full-text articles were included in the qualitative analysis. The majority of studies were retrospective reviews of nonrandomized data sets or qualitative investigations lacking formal control groups; there was 1 protocol for a future randomized controlled trial. Most studies demonstrated reduced lengths of stay and no increase in rates of readmissions or complications after introduction of an ERAS pathway.CONCLUSIONSThese introductory studies demonstrate the potential of ERAS protocols, when applied to spine procedures, to reduce lengths of stay, accelerate return of function, minimize postoperative pain, and save costs.

KEYWORDS:

ACDF = anterior cervical discectomy and fusion; AD = accelerated discharge; AIS = adolescent idiopathic scoliosis; ERAS = enhanced recovery after surgery; ERSS = enhanced recovery after spine surgery; LOS = length of stay; PCA = patient-controlled analgesia; PSF = posterior spinal fusion; RCT = randomized controlled trial; TD = traditional discharge; TLIF = transforaminal lumbar interbody fusion; degenerative spine disease; enhanced recovery after surgery; fast-track recovery; minimally invasive surgery; scoliosis; spine surgery

PMID:
30933920
DOI:
10.3171/2019.1.FOCUS18700

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