Retrospective Data Analysis for Enhanced Recovery After Surgery (ERAS) Protocol for Elderly Patients with Long-Level Lumbar Fusion

Abstract

Enhanced recovery after surgery (ERAS) for spinal surgery is new; specifically, an ERAS program for elderly patients is lacking. Geriatric patients have special characteristics that result in further harm by surgical stress. ERAS interventions are designed to improve recovery after surgery and can result in substantial benefits in clinical outcomes and cost-effectiveness. We aimed to determine whether ERAS significantly improved satisfaction and outcomes in elderly patients with long-level lumbar fusion. Patients >70 years old with lumbar disc herniation or lumbar spinal stenosis who underwent lumbar fusion of ≥3 levels from July 2019 to June 2021 (ERAS group) and from January 2018 to June 2019 (non-ERAS group) were enrolled. Demographic, comorbidity, and surgical data were collected from electronic medical records. ERAS interventions were categorized as preoperative, intraoperative, and postoperative. We also evaluated primary outcome, surgical complications, and length of stay (LOS). The study included 154 patients, 72 in the ERAS group and 82 case-matched patients in the non-ERAS group. Overall, ERAS pathway compliance was 91%. There were no significant differences in readmission and mortality rates at 30-day follow-up between the ERAS and non-ERAS groups. Statistically significant decreases were observed in the ERAS group in complications (6 in ERAS group vs. 19 in non-ERAS group, P= 0.013) and LOS (17.74 ± 5.56 days in ERAS group vs. 22.13 ± 12.21 days in non-ERAS group, P= 0.041). Multivariable linear regression showed that implementation of ERAS (P= 0.002) was correlated with LOS. Multivariable logistic regression showed that implementation of ERAS (P= 0.004) was correlated with complications. The ERAS protocol used in elderly patients after long-level lumbar fusion surgery was safe and associated with incremental benefits regarding complications and LOS.