Enhanced Recovery After Surgery (ERAS) for Spine Surgery: A Systematic Review

Nicholas Dietz, M. Sharma, S. Adams, A. Alhourani, Beatrice Ugiliweneza, Dengzhi Wang, Miriam A Nuno, Doniel Drazin, Maxwell Boakye

Research output: Contribution to journalReview article

Abstract

Background: Enhanced recovery after surgery (ERAS) represents an evidence-based multidisciplinary approach to perioperative management after major surgery that decreases complications and readmissions and improves functional recovery. Spine surgery is a traditionally invasive intervention with an extended recovery phase and may benefit from ERAS protocol integration. Methods: We analyzed the use of ERAS in spine surgery by completing a search using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and the PICOS (Participants, Intervention, Comparison, Outcomes, Study Design) model through PubMed and Ovid databases to identify studies that fit our search criteria. We assess the outcomes and ERAS elements selected across protocols as well as the study design and internal validation methods. Results: A total of 19 studies met the inclusion criteria and were used in our analysis. Patient populations differed significantly across all 4 studies. Reduction in length of stay was reported in 7 studies using the ERAS protocol. Comparative studies between ERAS and non-ERAS show improved pain scores and reduced opioid consumption postoperatively, but no differences in complications or readmissions between groups. Complication rates under ERAS protocols ranged from 2.0% to 31.7%. Significant pain reduction in visual analog scale scores was observed with 3 ERAS protocols. Direct, indirect, and total cost decreases were also observed with implementation of ERAS protocols. Conclusions: A limited cohort of studies with significant variability in patient population and ERAS protocol implementation have evaluated the integration of ERAS within spine surgery. ERAS in spine surgery may provide reductions in complications, readmissions, length of stay, and opioid use, in combination with improvements in patient-reported outcomes and functional recovery.

Original languageEnglish (US)
Pages (from-to)415-426
Number of pages12
JournalWorld Neurosurgery
Volume130
DOIs
StatePublished - Oct 1 2019

Fingerprint

Spine
Opioid Analgesics
Length of Stay
Pain
Visual Analog Scale
PubMed
Population
Meta-Analysis
Cohort Studies
Outcome Assessment (Health Care)

Keywords

  • Enhanced recovery after surgery
  • ERAS
  • Fast-track recovery
  • Laminectomy
  • Spine surgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Dietz, N., Sharma, M., Adams, S., Alhourani, A., Ugiliweneza, B., Wang, D., ... Boakye, M. (2019). Enhanced Recovery After Surgery (ERAS) for Spine Surgery: A Systematic Review. World Neurosurgery, 130, 415-426. https://doi.org/10.1016/j.wneu.2019.06.181

Enhanced Recovery After Surgery (ERAS) for Spine Surgery : A Systematic Review. / Dietz, Nicholas; Sharma, M.; Adams, S.; Alhourani, A.; Ugiliweneza, Beatrice; Wang, Dengzhi; Nuno, Miriam A; Drazin, Doniel; Boakye, Maxwell.

In: World Neurosurgery, Vol. 130, 01.10.2019, p. 415-426.

Research output: Contribution to journalReview article

Dietz, N, Sharma, M, Adams, S, Alhourani, A, Ugiliweneza, B, Wang, D, Nuno, MA, Drazin, D & Boakye, M 2019, 'Enhanced Recovery After Surgery (ERAS) for Spine Surgery: A Systematic Review', World Neurosurgery, vol. 130, pp. 415-426. https://doi.org/10.1016/j.wneu.2019.06.181
Dietz N, Sharma M, Adams S, Alhourani A, Ugiliweneza B, Wang D et al. Enhanced Recovery After Surgery (ERAS) for Spine Surgery: A Systematic Review. World Neurosurgery. 2019 Oct 1;130:415-426. https://doi.org/10.1016/j.wneu.2019.06.181
Dietz, Nicholas ; Sharma, M. ; Adams, S. ; Alhourani, A. ; Ugiliweneza, Beatrice ; Wang, Dengzhi ; Nuno, Miriam A ; Drazin, Doniel ; Boakye, Maxwell. / Enhanced Recovery After Surgery (ERAS) for Spine Surgery : A Systematic Review. In: World Neurosurgery. 2019 ; Vol. 130. pp. 415-426.
@article{3b0fbd1deb7947dbb0e8f27e09d33b94,
title = "Enhanced Recovery After Surgery (ERAS) for Spine Surgery: A Systematic Review",
abstract = "Background: Enhanced recovery after surgery (ERAS) represents an evidence-based multidisciplinary approach to perioperative management after major surgery that decreases complications and readmissions and improves functional recovery. Spine surgery is a traditionally invasive intervention with an extended recovery phase and may benefit from ERAS protocol integration. Methods: We analyzed the use of ERAS in spine surgery by completing a search using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and the PICOS (Participants, Intervention, Comparison, Outcomes, Study Design) model through PubMed and Ovid databases to identify studies that fit our search criteria. We assess the outcomes and ERAS elements selected across protocols as well as the study design and internal validation methods. Results: A total of 19 studies met the inclusion criteria and were used in our analysis. Patient populations differed significantly across all 4 studies. Reduction in length of stay was reported in 7 studies using the ERAS protocol. Comparative studies between ERAS and non-ERAS show improved pain scores and reduced opioid consumption postoperatively, but no differences in complications or readmissions between groups. Complication rates under ERAS protocols ranged from 2.0{\%} to 31.7{\%}. Significant pain reduction in visual analog scale scores was observed with 3 ERAS protocols. Direct, indirect, and total cost decreases were also observed with implementation of ERAS protocols. Conclusions: A limited cohort of studies with significant variability in patient population and ERAS protocol implementation have evaluated the integration of ERAS within spine surgery. ERAS in spine surgery may provide reductions in complications, readmissions, length of stay, and opioid use, in combination with improvements in patient-reported outcomes and functional recovery.",
keywords = "Enhanced recovery after surgery, ERAS, Fast-track recovery, Laminectomy, Spine surgery",
author = "Nicholas Dietz and M. Sharma and S. Adams and A. Alhourani and Beatrice Ugiliweneza and Dengzhi Wang and Nuno, {Miriam A} and Doniel Drazin and Maxwell Boakye",
year = "2019",
month = "10",
day = "1",
doi = "10.1016/j.wneu.2019.06.181",
language = "English (US)",
volume = "130",
pages = "415--426",
journal = "World Neurosurgery",
issn = "1878-8750",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Enhanced Recovery After Surgery (ERAS) for Spine Surgery

T2 - A Systematic Review

AU - Dietz, Nicholas

AU - Sharma, M.

AU - Adams, S.

AU - Alhourani, A.

AU - Ugiliweneza, Beatrice

AU - Wang, Dengzhi

AU - Nuno, Miriam A

AU - Drazin, Doniel

AU - Boakye, Maxwell

PY - 2019/10/1

Y1 - 2019/10/1

N2 - Background: Enhanced recovery after surgery (ERAS) represents an evidence-based multidisciplinary approach to perioperative management after major surgery that decreases complications and readmissions and improves functional recovery. Spine surgery is a traditionally invasive intervention with an extended recovery phase and may benefit from ERAS protocol integration. Methods: We analyzed the use of ERAS in spine surgery by completing a search using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and the PICOS (Participants, Intervention, Comparison, Outcomes, Study Design) model through PubMed and Ovid databases to identify studies that fit our search criteria. We assess the outcomes and ERAS elements selected across protocols as well as the study design and internal validation methods. Results: A total of 19 studies met the inclusion criteria and were used in our analysis. Patient populations differed significantly across all 4 studies. Reduction in length of stay was reported in 7 studies using the ERAS protocol. Comparative studies between ERAS and non-ERAS show improved pain scores and reduced opioid consumption postoperatively, but no differences in complications or readmissions between groups. Complication rates under ERAS protocols ranged from 2.0% to 31.7%. Significant pain reduction in visual analog scale scores was observed with 3 ERAS protocols. Direct, indirect, and total cost decreases were also observed with implementation of ERAS protocols. Conclusions: A limited cohort of studies with significant variability in patient population and ERAS protocol implementation have evaluated the integration of ERAS within spine surgery. ERAS in spine surgery may provide reductions in complications, readmissions, length of stay, and opioid use, in combination with improvements in patient-reported outcomes and functional recovery.

AB - Background: Enhanced recovery after surgery (ERAS) represents an evidence-based multidisciplinary approach to perioperative management after major surgery that decreases complications and readmissions and improves functional recovery. Spine surgery is a traditionally invasive intervention with an extended recovery phase and may benefit from ERAS protocol integration. Methods: We analyzed the use of ERAS in spine surgery by completing a search using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and the PICOS (Participants, Intervention, Comparison, Outcomes, Study Design) model through PubMed and Ovid databases to identify studies that fit our search criteria. We assess the outcomes and ERAS elements selected across protocols as well as the study design and internal validation methods. Results: A total of 19 studies met the inclusion criteria and were used in our analysis. Patient populations differed significantly across all 4 studies. Reduction in length of stay was reported in 7 studies using the ERAS protocol. Comparative studies between ERAS and non-ERAS show improved pain scores and reduced opioid consumption postoperatively, but no differences in complications or readmissions between groups. Complication rates under ERAS protocols ranged from 2.0% to 31.7%. Significant pain reduction in visual analog scale scores was observed with 3 ERAS protocols. Direct, indirect, and total cost decreases were also observed with implementation of ERAS protocols. Conclusions: A limited cohort of studies with significant variability in patient population and ERAS protocol implementation have evaluated the integration of ERAS within spine surgery. ERAS in spine surgery may provide reductions in complications, readmissions, length of stay, and opioid use, in combination with improvements in patient-reported outcomes and functional recovery.

KW - Enhanced recovery after surgery

KW - ERAS

KW - Fast-track recovery

KW - Laminectomy

KW - Spine surgery

UR - http://www.scopus.com/inward/record.url?scp=85070557867&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85070557867&partnerID=8YFLogxK

U2 - 10.1016/j.wneu.2019.06.181

DO - 10.1016/j.wneu.2019.06.181

M3 - Review article

C2 - 31276851

AN - SCOPUS:85070557867

VL - 130

SP - 415

EP - 426

JO - World Neurosurgery

JF - World Neurosurgery

SN - 1878-8750

ER -