Pahwa Anuj, Gong Houchen, Li Yingda
Department of Neurosurgery, Westmead Hospital, Westmead, NSW, Australia.
J Spine Surg. 2024 Mar 20;10(1):30-39. doi: 10.21037/jss-23-115. Epub 2024 Jan 16.
The principles of enhanced recovery after surgery (ERAS) aim to reduce the physiological stress of surgery which in turn improve clinical and health economic outcomes. There is ample evidence in literature supporting ERAS methodologies in other surgical specialties, but its adoption in spinal surgery, especially in Australia remains in infancy. The aim of this project is to describe the early experience with an evidence-based ERAS pathway for simple spine surgery, a first of its kind in Australia.
An ERAS protocol was designed using an evidenced-based review of the literature. The authors then conducted a prospective cohort analysis looking at outcome of patients undergoing elective spinal (lumbar and cervical) decompression surgery under ERAS principles by a single surgeon on the Westmead Hospital Campus between March 2021 to May 2023. Primary outcomes were patient length of stay (LOS), patient reported pain and disability scores and complications (including readmissions within 30 days and re-operation within 6 months). Secondary outcomes included predictors of failure for same-day discharge.
A total of 52 patients underwent spinal decompression surgeries under the ERAS protocol. Overall 43 out of 52 patients (83.7%) were successfully discharged on the same day as their surgery. Patient reported outcomes were improved at 6 weeks and 6 months confirming durability of intervention. The rates of complications were similar to literature reported rates for simple lumbar or cervical decompression procedures and there were no readmissions within 30 days or re-operations within 6 months of surgery. Being of non-English speaking background [odds ratio (OR) =6.08, P=0.04] and from home alone (OR =10.25, P=0.03) were predictors of failure of same day discharge in this small cohort.
Implementation of ERAS protocols for simple spinal decompression surgeries is feasible and produces durable improved patient outcomes while reducing LOS in hospitals. Patient social factors can be predictive of lack of compliance.
术后加速康复（ERAS）原则旨在减轻手术带来的生理应激，进而改善临床和卫生经济结局。文献中有大量证据支持ERAS方法在其他外科专科中的应用，但在脊柱外科领域，尤其是在澳大利亚，其应用仍处于起步阶段。本项目的目的是描述澳大利亚首个基于循证的简单脊柱手术ERAS路径的早期经验。
通过对文献进行循证回顾来设计ERAS方案。作者随后进行了一项前瞻性队列分析，观察2021年3月至2023年5月期间在韦斯特米德医院院区由一名外科医生按照ERAS原则进行择期脊柱（腰椎和颈椎）减压手术的患者的结局。主要结局包括患者住院时间（LOS）、患者报告的疼痛和残疾评分以及并发症（包括30天内再次入院和6个月内再次手术）。次要结局包括当日出院失败的预测因素。
共有52例患者按照ERAS方案接受了脊柱减压手术。总体而言，52例患者中有43例（83.7%）在手术当天成功出院。患者报告的结局在6周和6个月时有所改善，证实了干预的持久性。并发症发生率与文献报道的简单腰椎或颈椎减压手术的发生率相似，且在术后30天内无再次入院情况，6个月内无再次手术情况。在这个小队列中，非英语背景（优势比[OR]=6.08，P=0.04）和独自居住（OR=10.25，P=0.03）是当日出院失败的预测因素。
对简单脊柱减压手术实施ERAS方案是可行的，能持久改善患者结局，同时缩短住院时间。患者的社会因素可预测其依从性差。
