Abstract
BackgroundEnhanced recovery after surgery (ERAS) pathway in spine surgery is increasingly popular which can reduce the length of hospital stay (LOS). However, there are few studies on the safety and effectiveness of ERAS pathway in the treatment of single-level lumbar disc herniation (LDH) by percutaneous endoscopic transforaminal discectomy (PETD). The aim of this study was to investigate whether ERAS can reduce LOS of patients with single segment LDH treated by PETD.MethodsWe reviewed the outcomes of all LDH patients (L4/5) who had been treated with PETD at our institution. Quasi-experimental study was adopted between patients treated in an ERAS after PETD with those rehabilitated on a traditional pathway. The two groups were analyzed for LOS, operation time, complications, visual analog scale (VAS), Oswestry Dysfunction Index (ODI), hospitalization expenses (HE), and improved MacNab efficacy assessment criteria (MacNab).ResultsA total of 120 single segment LDH patients (ERAS pathway 60 cases, traditional care pathway 60 cases) who were selected from January 2019 to January 2021 met the inclusion criteria. There was a significant difference in mean LOS postoperative VAS scores and ODI on the 3rd day after surgery between the two groups (P < 0.05). The incidence of complications and HE were similar in the two groups (P > 0.05). The mean LOS decreased from 3.47 ± 1.14 days to 5.65 ± 1.39 days after application of ERAS pathway (P < 0.05).ConclusionsThe ERAS pathway reduced LOS without resulting in additional complications after PETD. These findings support the application of the perioperative ERAS pathway in the treatment of single-level LDH with PETD.Level of evidenceLevel IV, therapeutic
Highlights
Enhanced recovery after surgery (ERAS) is a multimodal clinical pathway designed to reduce surgical stress and postoperative catabolism and promote the recovery of postoperative body function [1, 2]
Ethical approval was obtained from the internal review board, and orthopedic departmental approval was gained to proceed with prospective data collection
Local anesthesia was used as the main anesthesia method in both ERAS group and traditional group
Summary
ERAS (enhanced recovery after surgery) is a multimodal clinical pathway designed to reduce surgical stress and postoperative catabolism and promote the recovery of postoperative body function [1, 2]. The core of this concept is to follow the principle of evidence-based medicine, integrate and optimize perioperative intervention measures on the basis of multidisciplinary cooperation, promote postoperative recovery, shorten LOS, reduce postoperative complications, and reduce the risk of readmission [1,2,3]. There are few studies on the safety and effectiveness of ERAS pathway in the treatment of single-level lumbar disc herniation (LDH) by percutaneous endoscopic transforaminal discectomy (PETD).
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