Centre for Spinal Studies and Surgery, D Floor, West Block, Queens Medical Centre, Derby Road, Nottingham, NG7 2UH, UK.
Spine Deform. 2021 Jul;9(4):893-904. doi: 10.1007/s43390-021-00310-w. Epub 2021 Mar 16.
A systematic review reporting on the efficacy of an ERAS protocol in patients undergoing spinal fusion for AIS.
To systematically evaluate the relevant literature pertaining to the efficacy of ERAS protocols with respect to the length of stay, complication, and readmission rates in patients undergoing posterior spinal corrective surgery for AIS. ERAS is a multidisciplinary approach aimed at improving outcomes of surgery by a specific evidence-based protocol. The rationale of this rapid recovery regimen is to maintain homeostasis so as to reduce the postoperative stress response and pain. No thorough review of available information for its use in AIS has been published.
A systematic review of the English language literature was undertaken using search criteria (postoperative recovery AND adolescent idiopathic scoliosis) using the PRISMA guidelines (Jan 1999-May 2020). Isolated case reports and case series with < 5 patients were excluded. Length of stay (LOS), complication and readmission rates were used as outcome measures. Statistical analysis was done using the random effects model.
Of a total of 24 articles, 10 studies met the inclusion criteria (9 were Level III and 1 of level IV evidence) and were analyzed. Overall, 1040 patients underwent an ERAS-type protocol following posterior correction of scoliosis and were compared to 959 patients following traditional protocols. There was a significant reduction in the length of stay in patients undergoing ERAS when compared to traditional protocols (p < 0.00001). There was no significant difference in the complication (p = 0.19) or readmission rates (p = 0.30). Each protocol employed a multidisciplinary approach focusing on optimal pain management, nursing care, and physiotherapy.
This systematic review demonstrates advantages with ERAS protocols by significantly reducing the length of stay without increasing the complications or readmission rates as compared to conventional protocols. However, current literature on ERAS in AIS is restricted largely to retrospective studies with non-randomized data, and initial cohort studies lacking formal control groups.
一项系统评价报告，评估在接受脊柱融合术治疗 AIS 的患者中，使用加速康复（ERAS）方案的疗效。
系统评估与 ERAS 方案相关的文献，以评估其在接受后路脊柱矫正手术治疗 AIS 的患者中，在住院时间、并发症和再入院率方面的疗效。ERAS 是一种多学科方法，旨在通过特定的循证方案改善手术结果。这种快速康复方案的基本原理是维持内环境稳定，以减少术后应激反应和疼痛。目前尚未发表对其在 AIS 中应用的全面综述。
采用 PRISMA 指南（1999 年 1 月至 2020 年 5 月）的检索标准（术后恢复和青少年特发性脊柱侧凸），对英文文献进行系统评价。排除了仅有 5 例以下患者的单独病例报告和病例系列研究。住院时间（LOS）、并发症和再入院率用作结局指标。采用随机效应模型进行统计学分析。
在总共 24 篇文章中，有 10 项研究符合纳入标准（9 项为 III 级证据，1 项为 IV 级证据）并进行了分析。总体而言，1040 例患者接受了 ERAS 型方案，用于后路矫正脊柱侧凸，与 959 例接受传统方案的患者进行了比较。与传统方案相比，接受 ERAS 的患者的住院时间明显缩短（p<0.00001）。并发症（p=0.19）或再入院率（p=0.30）无显著差异。每个方案都采用了多学科方法，重点是最佳疼痛管理、护理和物理治疗。
这项系统评价表明，与传统方案相比，ERAS 方案具有明显缩短住院时间的优势，而不会增加并发症或再入院率。然而，目前关于 AIS 中 ERAS 的文献主要局限于回顾性研究和缺乏正式对照组的初始队列研究。
3 级。
