Department of Orthopedics, Xuanwu Hospital of Capital Medical University, Beijing, China; National Clinical Research Center for Geriatric Diseases, Beijing, China; Beijing Municipal Geriatric Medical Research Center, Beijing, China.
Department of Radiology, Cancer Hospital Chinese Academy of Medical Sciences, Beijing, China.
World Neurosurg. 2022 Aug;164:e397-e403. doi: 10.1016/j.wneu.2022.04.109. Epub 2022 May 2.
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.
脊柱手术的加速康复外科（ERAS）是一种新方法；特别是，针对老年患者的 ERAS 方案还比较缺乏。老年患者具有特殊的特征，这会导致手术应激带来进一步的伤害。ERAS 干预旨在改善手术后的恢复，并可在临床结果和成本效益方面带来显著益处。我们旨在确定 ERAS 是否能显著改善长节段腰椎融合老年患者的满意度和结果。
纳入 2019 年 7 月至 2021 年 6 月（ERAS 组）和 2018 年 1 月至 2019 年 6 月（非 ERAS 组）行≥3 个节段腰椎融合术的>70 岁腰椎间盘突出症或腰椎管狭窄症患者。从电子病历中收集人口统计学、合并症和手术数据。ERAS 干预措施分为术前、术中、术后。我们还评估了主要结果、手术并发症和住院时间（LOS）。
共纳入 154 例患者，ERAS 组 72 例，非 ERAS 组 82 例。总体而言，ERAS 路径的依从率为 91%。在 30 天随访时，ERAS 组和非 ERAS 组的再入院率和死亡率无显著差异。ERAS 组并发症（ERAS 组 6 例，非 ERAS 组 19 例，P=0.013）和 LOS（ERAS 组 17.74±5.56 天，非 ERAS 组 22.13±12.21 天，P=0.041）均有显著下降。多变量线性回归显示，实施 ERAS（P=0.002）与 LOS 相关。多变量逻辑回归显示，实施 ERAS（P=0.004）与并发症相关。
在长节段腰椎融合术后老年患者中使用 ERAS 方案是安全的，并且在并发症和 LOS 方面具有增量收益。
