Paris-Versailles Spine Center (Centre Francilien du Dos), Paris, France; Ramsay Santé-Hôpital Privé de Versailles, Versailles, France.
Research Institute, Bournemouth University, Bournemouth, UK; The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, Bournemouth, UK.
Spine J. 2021 May;21(5):729-752. doi: 10.1016/j.spinee.2021.01.001. Epub 2021 Jan 12.
Enhanced Recovery After Surgery (ERAS) evidence-based protocols for perioperative care have led to improvements in outcomes in numerous surgical areas, through multimodal optimization of patient pathway, reduction of complications, improved patient experience and reduction in the length of stay. ERAS represent a relatively new paradigm in spine surgery.
This multidisciplinary consensus review summarizes the literature and proposes recommendations for the perioperative care of patients undergoing lumbar fusion surgery with an ERAS program.
This is a review article.
Under the impetus of the ERAS® society, a multidisciplinary guideline development group was constituted by bringing together international experts involved in the practice of ERAS and spine surgery. This group identified 22 ERAS items for lumbar fusion. A systematic search in the English language was performed in MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. Systematic reviews, randomized controlled trials, and cohort studies were included, and the evidence was graded according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Consensus recommendation was reached by the group after a critical appraisal of the literature.
Two hundred fifty-six articles were included to develop the consensus statements for 22 ERAS items; one ERAS item (prehabilitation) was excluded from the final summary due to very poor quality and conflicting evidence in lumbar spinal fusion. From these remaining 21 ERAS items, 28 recommendations were included. All recommendations on ERAS protocol items are based on the best available evidence. These included nine preoperative, eleven intraoperative, and six postoperative recommendations. They span topics from preoperative patient education and nutritional evaluation, intraoperative anesthetic and surgical techniques, and postoperative multimodal analgesic strategies. The level of evidence for the use of each recommendation is presented.
Based on the best evidence available for each ERAS item within the multidisciplinary perioperative care pathways, the ERAS® Society presents this comprehensive consensus review for perioperative care in lumbar fusion.
围手术期护理的加速康复外科（ERAS）循证方案通过优化患者路径、减少并发症、改善患者体验和缩短住院时间，已使众多外科领域的治疗结果得到改善。ERAS 是脊柱外科领域的一种相对较新的模式。
本多学科共识综述总结了相关文献，并针对接受腰椎融合术的患者围手术期采用 ERAS 方案提出了相关建议。
这是一篇综述文章。
在 ERAS®学会的推动下，由参与 ERAS 和脊柱外科实践的国际专家组成了一个多学科指南制定小组。该小组确定了 22 项腰椎融合术的 ERAS 项目。在 MEDLINE、Embase 和 Cochrane 对照试验中心注册库中进行了英语系统检索。纳入系统评价、随机对照试验和队列研究，并根据推荐、评估、发展和评价（GRADE）系统对证据进行分级。小组对文献进行严格评价后达成共识推荐。
共纳入 256 篇文章，以制定 22 项 ERAS 项目的共识声明；由于腰椎脊柱融合术的证据质量较差且存在矛盾，其中一项 ERAS 项目（术前康复）被排除在最终总结之外。在剩下的 21 项 ERAS 项目中，共包含 28 项推荐。所有关于 ERAS 方案项目的建议均基于现有最佳证据。这些建议包括 9 项术前、11 项术中及 6 项术后建议。它们涵盖了从术前患者教育和营养评估、术中麻醉和手术技术到术后多模式镇痛策略等多个方面。同时，还展示了使用每个建议的证据级别。
基于多学科围手术期护理路径中每个 ERAS 项目的最佳可用证据，ERAS®学会针对腰椎融合术围手术期护理提出了这项全面的共识综述。
