Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Oct 21;13(20):6285.
doi: 10.3390/jcm13206285.

Enhanced Recovery After Surgery Protocols in One- or Two-Level Posterior Lumbar Fusion: Improving Postoperative Outcomes

Ji Uk Choi  1 , Tae-Hong Kee  1 , Dong-Ho Lee  1 , Chang Ju Hwang  1 , Sehan Park  1 , Jae Hwan Cho  1
Affiliations

Enhanced Recovery After Surgery Protocols in One- or Two-Level Posterior Lumbar Fusion: Improving Postoperative Outcomes

Ji Uk Choi et al. J Clin Med. .

Abstract

Background/Objectives: Enhanced recovery after surgery (ERAS) protocols optimize perioperative care and improve recovery. This study evaluated the effectiveness of ERAS in one- or two-level posterior lumbar fusion surgeries, focusing on perioperative medication use, pain management, and functional outcomes. Methods: Eighty-eight patients undergoing lumbar fusion surgery between March 2021 and February 2022 were allocated into pre-ERAS (n = 41) and post-ERAS (n = 47) groups. Outcomes included opioid and antiemetic consumption, pain scores (numerical rating scale (NRS)), functional recovery (Oswestry Disability Index (ODI) and EuroQol 5 Dimension (EQ-5D)), and complication rates. Pain was assessed daily for the first four postoperative days and at 6 months. Linear Mixed Effects Model analysis evaluated pain trajectories. Results: The post-ERAS group showed significantly lower opioid (p = 0.005) and antiemetic (p < 0.001) use. No significant differences were observed in NRS pain scores in the first 4 postoperative days. At 6 months, the post-ERAS group reported significantly lower leg pain (p = 0.002). The time:group interaction was not significant for back (p = 0.848) or leg (p = 0.503) pain. Functional outcomes at 6 months, particularly ODI and EQ-5D scores, showed significant improvement in the post-ERAS group. Complication rates were lower in the post-ERAS group (4.3% vs. 19.5%, p = 0.024), while hospital stay and fusion rates remained similar. Conclusions: The ERAS protocol significantly reduced opioid and antiemetic use, improved long-term pain management and functional recovery, and lowered complication rates in lumbar fusion patients. These findings support the implementation of ERAS protocols in spinal surgery, emphasizing their role in enhancing postoperative care.

Keywords: ERAS; antiemetic use; enhanced recovery after surgery; functional recovery; lumbar spinal fusion; multimodal analgesia; opioid reduction; postoperative outcomes; postoperative pain management.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flow diagram for the study sample selection. ERAS, Enhanced Recovery After Surgery; ALIF, anterior lumbar interbody fusion; OLIF, oblique lumbar interbody fusion.
Figure 2
Figure 2
Comparison between the pre- and postoperative scores.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br. J. Anaesth. 1997;78:606–617. doi: 10.1093/bja/78.5.606. - DOI - PubMed
    1. Debono B., Wainwright T.W., Wang M.Y., Sigmundsson F.G., Yang M.M.H., Smid-Nanninga H., Bonnal A., Le Huec J.C., Fawcett W.J., Ljungqvist O., et al. Consensus statement for perioperative care in lumbar spinal fusion: Enhanced Recovery After Surgery (ERAS(R)) Society recommendations. Spine J. 2021;21:729–752. doi: 10.1016/j.spinee.2021.01.001. - DOI - PubMed
    1. Ljungqvist O., Scott M., Fearon K.C. Enhanced Recovery After Surgery: A Review. JAMA Surg. 2017;152:292–298. doi: 10.1001/jamasurg.2016.4952. - DOI - PubMed
    1. Kim H.J., Steinhaus M., Punyala A., Shah S., Elysee J.C., Lafage R., Riviera T., Mendez G., Ojadi A., Tuohy S., et al. Enhanced recovery pathway in adult patients undergoing thoracolumbar deformity surgery. Spine J. 2021;21:753–764. doi: 10.1016/j.spinee.2021.01.003. - DOI - PubMed
    1. Porche K., Yan S., Mohamed B., Garvan C., Samra R., Melnick K., Vaziri S., Seubert C., Decker M., Polifka A., et al. Enhanced recovery after surgery (ERAS) improves return of physiological function in frail patients undergoing one- to two-level TLIFs: An observational retrospective cohort study. Spine J. 2022;22:1513–1522. doi: 10.1016/j.spinee.2022.04.007. - DOI - PMC - PubMed

LinkOut - more resources