Department of Neurosurgery, Geneva University Hospitals, Rue Gabrielle Perret Gentil 4, 1205, Geneva, Switzerland.
Acta Neurochir (Wien). 2020 Jun;162(6):1371-1377. doi: 10.1007/s00701-020-04293-x. Epub 2020 Apr 3.
Enhanced Recovery After Surgery (ERAS) is the object of numerous publications in various surgical fields. Still, its value in spine surgery is not as recognized as it is in other surgical domains. Our aim was to report neurosurgeons' opinions about ERAS in spine surgery.
From December 2019 to January 2020, members of the European Association of Neurosurgical Societies were asked to complete an online questionnaire regarding ERAS in spine surgery.
N = 234 participants responded to the survey (60% spine neurosurgeons; 22.6% working in private practice). Thirty-two percent reported to have more than 20 years of experience, followed by surgeons having between 5 and 10 (27.4%), 10-15 (17.9%), 15-20 (12%), and 0-5 years (10.7%). Gender distribution (12% vs 27% female gender, p = 0.04), private practice activity (28% vs 14%, p = 0.01), familiarity with the ERAS concept (57.4% vs 27%, p < 0.0001), and its implementation in the daily clinical practice (47.5% vs 18.3%, p < 0.0001) were statistically different between spine and general neurosurgeons. 54.7% of the surgeons were unfamiliar with ERAS in spine surgery. 63.7% considered ERAS as a progress; 36% declared to implement ERAS in their daily clinical practice. 1.7% reported ERAS as a decrease in the quality of management. 6.8% considered ERAS as not having an impact on patient care; 27.8% had no opinion. There were no differences in opinion on ERAS and its implementation between surgeons working in private and public hospitals. 69.5% of the spine surgeons considered ERAS having a positive impact on patient management, versus 55% of non-spine surgeons (p = 0.02).
Efforts are necessary to promote minimal invasive pre-, intra-, and postoperative workflow to improve patient management and reduce complications or side effects particularly adapted to spinal surgery. Specificities of spine patients, in terms of chronic pain, pre- and postoperative pain management, and psychological issues have to be considered.
加速康复外科（ERAS）是众多不同外科领域文献的研究对象。然而，它在脊柱外科中的价值尚未得到充分认可，这一点与其他外科领域不同。我们的目的是报告神经外科医生对脊柱外科中 ERAS 的看法。
从 2019 年 12 月至 2020 年 1 月，欧洲神经外科学会协会的成员被要求完成一项关于脊柱外科中 ERAS 的在线问卷调查。
共有 234 名参与者（60%为脊柱神经外科医生；22.6%在私人诊所工作）对调查做出了回应。32%的人报告说有超过 20 年的经验，其次是有 5 至 10 年（27.4%）、10 至 15 年（17.9%）、15 至 20 年（12%）和 0 至 5 年（10.7%）经验的医生。性别分布（12%对 27%女性，p=0.04）、私人执业活动（28%对 14%，p=0.01）、对 ERAS 概念的熟悉程度（57.4%对 27%，p<0.0001）和在日常临床实践中的实施（47.5%对 18.3%，p<0.0001）在脊柱神经外科医生和普通神经外科医生之间存在统计学差异。54.7%的医生对脊柱外科中的 ERAS 不熟悉。63.7%的医生认为 ERAS 是一种进步；36%的医生宣布在日常临床实践中实施 ERAS。1.7%的医生报告 ERAS 降低了管理质量。6.8%的医生认为 ERAS 对患者护理没有影响；27.8%的医生没有意见。在私人医院和公立医院工作的医生对 ERAS 及其实施的看法没有差异。69.5%的脊柱外科医生认为 ERAS 对患者管理有积极影响，而非脊柱外科医生的这一比例为 55%（p=0.02）。
有必要努力促进微创的术前、术中和术后工作流程，以改善患者管理并减少并发症或副作用，特别是专门针对脊柱手术。还必须考虑脊柱患者的特殊性，包括慢性疼痛、术前和术后疼痛管理以及心理问题。
