Comparison of interventions and outcomes of enhanced recovery after surgery: a systematic review and meta-analysis of 2456 adolescent idiopathic scoliosis cases

Enhanced recovery after surgery for adolescent idiopathic scoliosis: a revised systematic review and meta‑analysis

PURPOSE

Adolescent idiopathic scoliosis surgery (AIS) is often associated with high costs and significant recovery challenges. Enhanced recovery after surgery (ERAS) protocols aim to improve outcomes, reducing hospital stays and complications compared to traditional (TD) pathways. This study evaluates the impact of ERAS protocols on AIS treatment.

METHODS

Following PRISMA guidelines, a systematic review identified 30 studies (n = 15,954 patients). Search terms included "ERAS," "adolescent idiopathic scoliosis," and "posterior spinal fusion." Outcomes assessed included surgical metrics, recovery milestones, complications, and pain. A meta-analysis was performed, and the risk of bias was evaluated using the MINORS score.

RESULTS

ERAS patients (n = 5582) had shorter surgical durations (- 23 min, p = 0.08) and reduced blood loss (- 126 mL, p = 0.033) compared to TD patients (n = 7916). Recovery milestones improved, including earlier ambulation (- 37.4 h, p < 0.0001), patient-controlled analgesia discontinuation (- 1.1 days, p < 0.0001), catheter removal (- 0.75 days, p < 0.001), and shorter hospital stays (- 1.7 days, p < 0.0001). Complications were lower in the ERAS group (4% vs. 8%, p = 0.0074), while wound-related complications and 30-day readmission rates were comparable. Pain scores were significantly reduced from surgery day to postoperative day 2 (p < 0.0181).

CONCLUSION

ERAS protocols improve recovery and reduce complications in AIS surgery, with shorter hospital stays and enhanced patient outcomes. These findings support broader implementation and further randomized trials to evaluate long-term benefits and patient satisfaction.

Quality improvement in neurosurgery: A systematic review

Quality improvement (QI) is crucial for advancing patient care and safety in surgical practices. Despite the presence of numerous systematic reviews on various types of surgeries, no current QI systematic review for neurosurgery is available, at least to the best of our knowledge. The present study thus aimed to explore existing QI frameworks, interventions and outcome measures, which are used to enhance patient care and efficiency in neurosurgery. For this purpose, a systematic review was conducted by identifying 75 articles using key words, such as 'Quality', 'Control', 'Improvement', 'Neurosurgical' and 'Neurosurgery' across various databases, including PubMed, Google Scholar, Scopus, Wiley, ScienceDirect and Microsoft Academic. Each article was assessed based on inclusion and exclusion criteria, without a time limit for selection. The analysis of the 75 publications revealed an uneven distribution across neurosurgical fields: Adult neurosurgery (70.5%), spine surgery (22.5%), pediatric neurosurgery (4%) and neuro-oncology (3%). This pattern was reflected in the patient distribution (n=621,293), with 87.07% involved in spine surgery QI initiatives. Cranial-only and combined cranial and spinal studies accounted for only 0.21% of patients. QI interventions included mainly new protocols (18.67%), ERAS (17.33%), data analysis (16%), modified checklists (14.67%) and new sterilization devices (13.3%). By contrast, only a limited number of articles addressed the effectiveness of new technology, prediction models, incident reporting and staff education. On the whole, the QI studies enhanced neurosurgical care, focusing mainly on adult neurosurgery and targeting specifically spinal cases. The main interventions included new protocols, ERAS, data analysis and checklists. Further research is required to address QI initiatives in cranial surgery and evaluate the effectiveness of less commonly used methods, such as new technologies and predictive models.

Application of an enhanced recovery after surgery care protocol in patients undergoing lumbar interbody fusion surgery: a meta-analysis

BACKGROUND

Enhanced recovery after surgery (ERAS) has been widely used in several surgical fields. This meta-analysis compared the clinical outcomes of the ERAS protocol and standard care (SC) in patients who underwent lumbar interbody fusion surgery.

MATERIALS AND METHODS

The PubMed, Web of Science, Cochrane Library, and Embase databases were systematically searched to identify studies reporting the effects of the ERAS protocol on clinical outcomes in patients who underwent lumbar interbody fusion surgery.

RESULTS

Overall, 15 studies involving 17 865 patients were included in the final analysis. With the ERAS protocol, the length of hospitalization (SMD: - 0.47, 95% CI - 0.56 to -0.38), postoperative complications (OR = 0.62; 95% CI 0.50 to 0.77), operation time (SMD = - 0.26; 95% CI - 0.44 to -0.09), postoperative pain (SMD = - 0.35; 95% CI - 0.64 to -0.07) and duration of ambulation (SMD = - 0.80; 95% CI - 1.02 to - 0.58) were significantly reduced. The rates of readmission (OR = 0.63; 95% CI 0.38 to 1.04), estimated blood loss (SMD = - 0.31; 95% CI - 0.69 to 0.06) and hospitalization costs (SMD: - 0.56, 95% CI - 1.27 to 0.14) did not significantly differ between the ERAS and SC groups.

CONCLUSIONS

The present meta-analysis indicated that the ERAS protocol could be safely and feasibly implemented in the perioperative management of patients receiving lumbar interbody fusion surgery. The protocol significantly reduced the length of hospitalization, incidence of postoperative complications, operation time, duration of 1st ambulation and duration of postoperative pain. However, no differences were observed in estimated blood loss, readmission rates or hospitalization costs.

Enhancing Recovery in Severe Adolescent Idiopathic Scoliosis (AIS) Patients With Cobb Angle ≥90 Degrees Undergoing Single-staged Posterior Spinal Fusion (PSF): Evaluating the Feasibility of Rapid Recovery Protocol (RRP)

STUDY DESIGN

Retrospective study.

OBJECTIVE

To assess the feasibility and outcome of rapid recovery protocol (RRP) in severe adolescent idiopathic scoliosis (AIS) patients with Cobb angle ≥90 degrees underwent single-staged posterior spinal fusion (PSF).

SUMMARY OF BACKGROUND DATA

Corrective surgeries in severe AIS patients entail a higher risk of prolonged operation, excessive bleeding, extended hospital stay, and higher complication rates compared with non-severe AIS patients. Implementation of RRP among severe AIS patients has not been reported.

METHODS

Thirty-seven severe AIS patients who underwent single-staged PSF surgery from 2019 to 2022 were recruited. The RRP consisted of a preoperative regime and counselling, intraoperative strategies to reduce operation duration and blood loss and an accelerated postoperative rehabilitation pathway. Outcome measures were operative time, blood loss, postoperative pain scores, patient-controlled analgesia (PCA) morphine usage, length of hospital stay, and recovery milestones. Descriptive statistics were reported in mean (SD) for numerical data, whereas categorical data were presented in n (%).

RESULTS

The mean operation duration was 173.5±39.4 minutes, and the mean blood loss was 1064.6±473.3 mL. The average postoperative hospital stay was 3.2±0.6 days. Twelve hours post-operation pain score was 4.0±2.0 and reduced to 3.9±1.6 at 48 hours. 78.4% of patients discontinued their PCA at 48 hours. First liquid intake was at 6.3±8.5 hours, whereas solid food consumption was initiated at 23.4±14.2 hours. The urinary catheter was removed at 17.8±7.6 hours. Patients started ambulation at 24±12.7 hours, first passed flatus at 37.7±20.4 hours and had their first bowel movement at 122.1±41.7 hours. Three complications (8.1%) were reported, which included superficial surgical site infection, proximal wound stitch abscess and superficial thermal injury due to forced air-warming blanket.

CONCLUSION

The implementation of the RRP after PSF in severe AIS patients was feasible and resulted in a short postoperative hospital stay of 3.2 days without increasing the risk of major complications, readmissions, and reoperations.

Current issues in the treatment of adolescent idiopathic scoliosis: a comprehensive narrative review

Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of unknown etiology that commonly affects adolescents, imposing significant socioeconomic burdens. Effective management necessitates a comprehensive approach that takes into account multiple factors, including growth potential and psychological issues. Despite significant advancements in AIS management, several questions regarding optimal treatment strategies persist. Recent technological advancements are transforming the treatment landscape, encompassing advancements in bracing, robotic-assisted deformity corrections, and other interventions. This review explores current issues debated in the literature concerning the treatment of AIS, focusing on contemporary high-level evidence (e.g., meta-analyses and randomized controlled trials). Furthermore, this review explores cutting-edge developments and future directions in AIS management, including the integration of artificial intelligence and augmented reality.

Predictors of follow-up care for critically-ill patients with seizures and epileptiform abnormalities on EEG monitoring

OBJECTIVE

Post-hospitalization follow-up visits are crucial for preventing long-term complications. Patients with electrographic epileptiform abnormalities (EA) including seizures and periodic and rhythmic patterns are especially in need of follow-up for long-term seizure risk stratification and medication management. We sought to identify predictors of follow-up.

METHODS

This is a retrospective cohort study of all patients (age ≥ 18 years) admitted to intensive care units that underwent continuous EEG (cEEG) monitoring at a single center between 01/2016-12/2019. Patients with EAs were included. Clinical and demographic variables were recorded. Follow-up status was determined using visit records 6-month post discharge, and visits were stratified as outpatient follow-up, neurology follow-up, and inpatient readmission. Lasso feature selection analysis was performed.

RESULTS

723 patients (53 % female, mean (std) age of 62.3 (16.4) years) were identified from cEEG records with 575 (79 %) surviving to discharge. Of those discharged, 450 (78 %) had outpatient follow-up, 316 (55 %) had a neurology follow-up, and 288 (50 %) were readmitted during the 6-month period. Discharge on antiseizure medications (ASM), younger age, admission to neurosurgery, and proximity to the hospital were predictors of neurology follow-up visits. Discharge on ASMs, along with longer length of stay, younger age, emergency admissions, and higher illness severity were predictors of readmission.

SIGNIFICANCE

ASMs at discharge, demographics (age, address), hospital care teams, and illness severity determine probability of follow-up. Parameters identified in this study may help healthcare systems develop interventions to improve care transitions for critically-ill patients with seizures and other EA.

Cryoanalgesia as the Essential Element of Enhanced Recovery after Surgery (ERAS) in Children Undergoing Thoracic Surgery-Scoping Review

This article aims to present cryoanalgesia as an inventive strategy for pain alleviation among pediatric patients. It underlines the tremendous need to align pain management with the principles of the enhanced recovery after surgery (ERAS) approach. The aim of the study was to review the patient outcomes of nerve cryoanalgesia during surgery reported with regard to ERAS in the literature. The literature search was performed using PubMed and Embase to identify articles on the use of cryoanalgesia in children. It excluded editorials, reviews, meta-analyses, and non-English articles. The analysis focused on the study methods, data analysis, patient selection, and patient follow-up. This review includes a total of 25 articles. Three of the articles report the results of cryoanalgesia implemented in ERAS protocol in children. The research outcome indicates shortened hospital stay, potential reduction in opioid dosage, and significant progress in physical rehabilitation. This paper also describes the first intraoperative utilization of intercostal nerve cryoanalgesia during the Nuss procedure in Poland, highlighting its effectiveness in pain management. Adding the cryoanalgesia procedure to multimodal analgesia protocol may facilitate the implementation of the ERAS protocol in pediatric patients.

Promoting postoperative recovery in patients with metastatic epidural spinal cord compression based on the concept of ERAS: a multicenter analysis of 304 patients

BACKGROUND CONTEXT

Enhanced recovery after surgery (ERAS) has proven beneficial for patients undergoing orthopedic surgery. However, the application of ERAS in the context of metastatic epidural spinal cord compression (MESCC) remains undefined.

PURPOSE

This study aims to establish a medical pathway rooted in the ERAS concept, with the ultimate goal of scrutinizing its efficacy in enhancing postoperative outcomes among patients suffering from MESCC.

STUDY DESIGN/SETTING

An observational cohort study.

PATIENT SAMPLE

A total of 304 patients with MESCC who underwent surgery were collected between January 2016 and January 2023 at two large tertiary hospitals.

OUTCOME MEASURES

Surgery-related variables, patient quality of life, and pain outcomes. Surgery-related variables in the study included surgery time, surgery site, intraoperative blood loss, and complication.

METHODS

From January 2020 onwards, ERAS therapies were implemented for MESCC patients in both institutions. Thus, the ERAS cohort included 138 patients with MESCC who underwent surgery from January 2020 to January 2023, whereas the traditional cohort consisted of 166 patients with MESCC who underwent surgery from January 2016 to December 2019. Clinical baseline characteristics, surgery-related features, and surgical outcomes were collected. Patient quality of life was evaluated using the Functional Assessment of Cancer Therapy-General Scale (FACT-G), and pain outcomes were assessed using the Visual Analogue Scale (VAS).

RESULTS

Comparison of baseline characteristics revealed that the two cohorts were similar (all p>.050), indicating comparable distribution of clinical characteristics. In terms of surgical outcomes, patients in the ERAS cohort exhibited lower intraoperative blood loss (p<.001), shorter postoperative hospital stays (p<.001), lower perioperative complication rates (p=.020), as well as significantly shorter time to ambulation (P<0.001), resumption of regular diet (p<.001), removal of urinary catheter (p<.001), initiation of radiation therapy (p<.001), and initiation of systemic internal therapy (p<.001) compared with patients in the traditional cohort. Regarding pain outcomes and quality of life, patients undergoing the ERAS program demonstrated significantly lower VAS scores (p<.010) and higher scores for physical (p<.001), social (p<.001), emotional (p<.001), and functional (p<.001) well-being compared with patients in the traditional cohort.

CONCLUSIONS

The ERAS program, renowned for its ability to expedite postoperative recuperation, emerges as a promising approach to ameliorate the recovery process in MESCC patients. Not only does it exhibit potential in enhancing pain management outcomes, but it also holds the promise of elevating the overall quality of life for these individuals. Future investigations should delve deeper into the intricate components of the ERAS program, aiming to unravel the precise mechanisms that underlie its remarkable impact on patient outcomes.

Similar Short-Term Outcomes of Adolescent Idiopathic Scoliosis Surgery with or without Drainage: A Systematic Review of the Literature and Meta-Analysis

The use of closed suction drains post posterior spinal fusion for adolescent idiopathic scoliosis (AIS) is common practice, although evidence on its impact is limited compared to that for knee and hip arthroplasty. This study aimed to assess the effect of closed suction drainage on short-term post-operative outcomes in AIS surgery. A systematic review following PRISMA guidelines was conducted, including studies comparing outcomes with and without drainage. Data on blood loss, transfusions, hospital stay, and complications were collected and subjected to meta-analysis. Five studies involving 772 patients were analyzed. The meta-analysis found no significant difference in blood transfusion rates (p = 0.107) or hospital stay (p = 0.457) between groups. Complications, including surgical site infections, were more common without drainage, though not statistically significant (p = 0.356). Reintervention rates were higher in the no-drainage group, but not significantly (p = 0.260). Overall, this review found no significant short-term outcome differences, suggesting clinical judgment should guide drainage decisions. Further research, particularly with enhanced recovery protocols, is warranted to clarify drainage's role in AIS surgery.

Enhanced recovery after surgery (ERAS) in sacral tumour surgery and comprehensive description of a multidisciplinary program: a prospective study in a specialized hospital in China

PURPOSE

There were fewer data to guide the application of enhanced recovery after surgery (ERAS) theory into sacral tumour surgery. In the present study, we were aiming to describe a multidisciplinary program of ERAS and evaluate the availability in sacral tumour surgery.

METHODS

This was a prospective study of patients with sacral tumour between March 2021 and September 2021 at a single centre. We proposed a multidisciplinary program of ERAS for pre-admission, preoperative, intraoperative, postoperative, and post-discharge clinical care which positively influenced outcomes of patients with sacral tumour. All patients were prospectively assigned into two groups, ERAS group in which patients received ERAS protocols (n = 63), No-ERAS group in which patients had conventional clinical pathways (n = 62). Patient data were collected which included demographics, preoperative preparation, detailed information of surgical procedure, 60-day reoperation rate, 60-day readmission, postoperative length of stay (PLOS), time to first ambulation and flatus after surgery, time to removal of last drainage tube, and visual analogue scale (VAS) score at first ambulation and discharge. Complications referred to ones that occurred within 60 days after surgery. The above parameters were compared between ERAS group and No-ERAS group.

RESULTS

Time to first ambulation after surgery in ERAS group (mean 20.9 h) was significantly shorter than that in No-ERAS group (mean 104.3 ho). Meanwhile, time to first flatus after surgery in ERAS group (mean 26.7 h) was also significantly shorter than that in No-ERAS group (mean 37.3 h). Patients in ERAS group had statistically shorter PLOS (10.7 days) as compared to that in No-ERAS group (13.8 days). In ERAS group, 19 of 63 patients (30.2%) were discharged within seven days after surgery as compared to seven of 62 patients (11.3%) in No-ERAS group. VAS score at first ambulation in ERAS group was not obviously higher than that in No-ERAS group though the time of first ambulation in ERAS group was statistically earlier than one in No-ERAS group. Furthermore, VAS score at discharge in ERAS group was significantly lower than that in No-ERAS group. The rate of postoperative incision necrosis was 6.3% (4/63) in ERAS group and 8.1% (5/62) in No-ERAS group and all of these nine patients underwent reoperation before discharge. The difference was not statistically significant in the wound complication of incision necrosis and 60-day reoperation rate. Only one readmission occurred in No-ERAS group due to the surgical site infection and also there was no significant difference of 60-day readmission rate between these two groups. Furthermore, there was no statistical difference of complications of femoral artery thrombosis and rectal rupture between ERAS group and No-ERAS group.

CONCLUSIONS

Our proposed ERAS pathway for sacral tumour surgery and early walking facilitate safe and prompt discharge. ERAS protocols of sacral tumour surgery could decrease PLOS without significantly increasing postoperative complications, 60-day readmission rate and 60-day reoperation rate. The application of ERAS pathway in the field of sacral tumour surgery should have personalized feature with regard to resection type.

Accelerated Protocols in Adolescent Idiopathic Scoliosis Surgery

Adolescent idiopathic scoliosis (AIS) is the most common form of scoliosis. Treatment depends on the degree of curvature, skeletal maturity, and age of the patient. Once the curve reaches 50 degrees, posterior spinal fusion (PSF) is necessary to stabilize the spine and prevent further progression of the curve. PSF causes significant trauma to the tissues and often results in significant pain postoperatively. The purpose of this article is to provide the audience with a review of preoperative, intraoperative, and postoperative pain control with an accelerated protocol in patients with AIS undergoing PSF.

Novel Interdisciplinary Enhanced Recovery after Surgery Protocol Implementation in Paediatric Orthopaedics

The enhanced recovery after surgery (ERAS) protocol is not routine management in paediatric orthopaedics. Cultural differences or assumptions about the financing of medical care in different countries encourage creative adaptation of general assumptions in local communities. The aim of this study was to compare the quality of the perioperative period before and after the introduction of an interdisciplinary protocol adopted to organisational conditions. A group of 4098 children were included in the "before-after" observational study. The data of 1553 patients (BEFORE group) were analysed in terms of compliance with the enhanced recovery after surgery protocol guidelines and the time and cost of hospitalisation over a 20-month period. A novel interdisciplinary protocol was developed, including an education and training app called BackOnFeet (BOF®), standardised hospital management, and the introduction of methods novel to Poland (intraoperative nerve cryoanalgesia in children). A further 2545 patients (AFTER group) were reassessed over a period of 20 months. It was found that the groups differed in hospitalisation time (p < 0.001), type of procedures, and percentage ratio of costs incurred to revenue generated. The usefulness of the BOF® app as an effective educational tool was demonstrated. The optimisation of perioperative management in paediatric orthopaedics based on novel tools and the interdisciplinary ERAS protocol is possible and brings tangible benefits in psychological, organisational, and financial terms.

Clinical Outcomes of Enhanced Recovery After Surgery Program in Elderly Patients Undergoing Transabdominal Preperitoneal

Background: Enhanced recovery after surgery (ERAS) protocol is an effective evidence-based multidisciplinary protocol to optimize the postsurgical recovery process through perioperative interventions. The aim of the present study was to evaluate the effects of ERAS program on operation-related indicators, complications, pain, and quality of life in patients older than 60 years undergoing the transabdominal preperitoneal (TAPP) approach. Methods: This was a retrospective study of prospectively collected data from a single institution. A total of 160 elderly patients who underwent TAPP were divided into two groups: 80 patients in the ERAS group from January 2019 to December 2020, and 80 patients in the non-ERAS group from January 2021 to December 2022 in the non-ERAS group, and the groups were managed with the ERAS protocol and conventional management, respectively. We compared differences in operation-related indicators, complications, pain, and quality of life between the two groups. Results: Operation-related indicators (exhaust time, postoperative eating time, time to first ambulation, hospitalization cost, and postoperative hospital stay) and early postoperative pain of the ERAS group were superior to those of the non-ERAS group, and the difference had statistical significance (P < .05). More importantly, our results demonstrated that compared with the non-ERAS group, the application of ERAS in inguinal hernia patients may reduce postoperative complications (urinary retention, chronic pain) and improve quality of life. Conclusion: The ERAS program might provide the efficiency and safety approach to optimize clinical outcomes in the elderly patients older than 60 years undergoing TAPP approach.

Effects of delayed ambulation following posterior spinal fusion for adolescent idiopathic scoliosis: a single institutional study

OBJECTIVE

Mobilizing out of bed and ambulation are key components of recovery following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). However, there remains a paucity of studies identifying risk factors associated with delayed ambulation and its impact on postoperative outcomes. The aim of this study was to investigate patient- and surgical-level risk factors associated with delayed ambulation and the ramifications of delayed ambulation on healthcare utilization for patients undergoing PSF for AIS.

METHODS

The medical records of 129 adolescent (10-18 years) patients diagnosed with AIS undergoing posterior spinal fusion at a major academic institution between 2013 and 2020 were reviewed. Patients were categorized based on days from surgery to ambulation: early (≤ 1 day), intermediate (2 days), or late (≥ 3 days). Patient demographics, comorbidities, spinal deformity characteristics, intraoperative variables, postoperative complications, LOS, and unplanned readmissions were assessed. The odds ratios for risk-adjusted delayed ambulation and extended LOS were determined via multivariate stepwise logistic regressions.

RESULTS

One Hundred and Twenty Nine patients were included in this study, of which 10.8% (n = 14) were classified as Early ambulators, 41.9% (n = 54) Intermediate ambulators, and 47.3% (n = 61) were Late ambulators. Late ambulators were significantly younger than early and intermediate ambulators (Early: 15.7 ± 1.9 years vs. Intermediate: 14.8 ± 1.7 years vs. Late: 14.1 ± 1.9 years, p = 0.010). The primary and secondary spinal curves were significantly worse among Late ambulators (p < 0.001 and p = 0.002 respectively). Fusion levels (p < 0.01), EBL (p = 0.014), and the rate of RBC transfusions (p < 0.001) increased as time to ambulation increased. Transition time from IV to oral pain medications (Early: 1.6 ± 0.8 days vs. Intermediate: 2.2 ± 0.6 days vs. Late: 2.4 ± 0.6 days, p < 0.001) and total hospital length of stay (Early: 3.9 ± 1.4 days vs. Intermediate: 4.7 ± 0.9 days vs. Late: 5.1 ± 1.2 days, p < 0.001) were longer in Late ambulators. On multivariate analysis, significant predictors of delayed ambulation included primary curve degree ≥ 70° [aOR: 5.67 (1.29‒31.97), p = 0.030] and procedure time [aOR: 1.66 (1.1‒2.59), p = 0.019].

CONCLUSIONS

Our study suggests that there may be patient- and surgical-level factors that are independently associated with late ambulation following PSF for AIS, including extent of major curve and length of operative time. Additionally, delayed ambulation has implications to length of hospital stay and postoperative complications.

Utilization of individual components of enhanced recovery after surgery (ERAS) protocol improves post-operative outcomes in adolescent idiopathic scoliosis: a blueprint for progressive adoption of ERAS

PURPOSE

Enhanced recovery after surgery [ERAS] is an approach for standardization of perioperative care aimed at improving patient outcomes. The primary aim of this study was to determine if length of stay (LOS) differed by protocol type (ERAS vs. non-ERAS [N-ERAS]) in patients undergoing surgery for adolescent idiopathic scoliosis (AIS).

METHODS

A retrospective cohort study was conducted. Patient characteristics were collected and compared between groups. Differences in LOS were assessed using regression adjusting for age, sex, BMI, pre-surgical Cobb angle, levels fused and year of surgery.

RESULTS

Fifty nine ERAS patients were compared to 81 N-ERAS patients. Patients were comparable in their baseline characteristics. Median LOS was 3 days (IQR = 3-4) for the ERAS group, compared to 5 days (IQR = 4-5) for the N-ERAS group (p < 0.001). The ERAS group had a significantly lower adjusted rate of stay (RR = 0.75; 95% CI = 0.62-0.92). The ERAS group had significantly lower average pain on post-operative days 0 (least-squares-mean [LSM] 2.66 vs. 4.41, p < 0.001), POD1 (LSM 3.12 vs. 4.48, p < 0.001) and POD5 (LSM 2.84 vs. 4.42, p = 0.035). The ERAS group had lower opioid consumption (p < 0.001). LOS was predicted by the number of protocol elements received; those receiving two (RR = 1.54 95% CI = 1.05-2.24), one (RR = 1.49; 95% CI = 1.09-2.03) or none (RR = 1.60, 95% CI = 1.21-2.13) had significantly longer rates of stay than those receiving all four.

CONCLUSION

Adoption of modified ERAS-based protocol for patients undergoing PSF for AIS led to significant reduction in LOS, average pain scores, and opioid consumption.

Treatment of patients with metastatic epidural spinal cord compression using an enhanced recovery after surgery program

Purpose: The aims of this study were to introduce a new medical, pathway based on the concept of "enhanced recovery after surgery" (ERAS) for patients with metastatic epidural spinal cord compression (MESCC), and to test whether the ERAS program could improve clinical metrics among such patients. Methods: Data from patients with MESCC (n = 98), collected between December 2016 and December 2019 (Non-ERAS cohort), and from 86 patients with metastatic epidural spinal cord compression collected between January 2020 and December 2022 (ERAS cohort), were retrospectively analyzed. Patients were treated by decompressive surgery combined with transpedicular screw implantation and internal fixation. Patient baseline clinical characteristics were collected and compared between the two cohorts. Surgical outcomes analyzed included operation time; intraoperative blood loss; postoperative length of hospital stay; time to ambulation, regular diet, urinary catheter removal, and radiation therapy; perioperative complications; anxiety; depression; and satisfaction with treatment. Results: No significant differences in clinical characteristics were found between the non-ERAS and enhanced recovery after surgery cohorts (all p > 0.050), indicating that the two cohorts were comparable. Regarding surgical outcomes, the enhanced recovery after surgery cohort had significantly less intraoperative blood loss (p < 0.001); shorter length of postoperative hospital stay (p < 0.001); shorter time to ambulation (p < 0.001), regular diet (p < 0.001), urinary catheter removal (p < 0.001), radiation administration (p < 0.001), and systemic internal therapy (p < 0.001); lower perioperative complication rate (p = 0.024); less postoperative anxiety (p = 0.041); and higher score for satisfaction with treatment (p < 0.001); whereas operation time (p = 0.524) and postoperative depression (p = 0.415) were similar between the two cohorts. Compliance analysis demonstrated that ERAS interventions were successfully conducted in the vast majority of patients. Conclusion: The enhanced recovery after surgery intervention is beneficial to patients with metastatic epidural spinal cord compression, according to data on intraoperative blood loss; length of hospital stay; time to ambulation, regular diet, urinary catheter removal, radiation exposure, and systemic internal therapy; perioperative complication; alleviation of anxiety; and improvement of satisfaction. However, clinical trials to investigate the effect of enhanced recovery after surgery are needed in the future.

The outcome of enhanced recovery after surgery vs. a traditional pathway in adolescent idiopathic scoliosis surgery: A retrospective comparative study

Objectives

Methods

Results

Conclusions