Yao Yu-Cheng, Liou Jing-Yang, Wang Hsin-Yi, Chou Po-Hsin, Lin Hsi-Hsien, Wang Shi-Tien
Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan.
Spine J. 2025 Aug;25(8):1588-1595. doi: 10.1016/j.spinee.2025.01.023. Epub 2025 Jan 31.
Enhanced Recovery After Surgery (ERAS) protocols have been shown to accelerate patient recovery across various surgical fields. There are growing reports of the benefits of ERAS for lumbar fusion, but the majority rely on retrospective analysis.
This study aimed to prospectively assess the impact of an ERAS protocol on perioperative outcomes in patients undergoing lumbar spinal fusion.
STUDY DESIGN/SETTING: Prospective comparative cohort study conducted at a tertiary medical center in Taipei, Taiwan, between November 2020 and May 2023.
The study included 242 patients undergoing lumbar spinal fusion for degenerative spinal conditions divided into ERAS and non-ERAS groups.
Main outcomes measured included operative duration, estimated blood loss (EBL), postoperative nausea and vomiting (PONV), analgesic use, and visual analog scale (VAS) pain score.
Propensity score matching (PSM) was used to minimize confounders between the 2 groups. Differences between the 2 groups were assessed using the 2-sample independent t-test or nonparametric Mann-Whitney U test for continuous variables, and the chi-square test or Fisher's exact test for categorical variables.
The ERAS group had significantly shorter operative time (202±68 min vs 255±85 min) and EBL (480±302 ml vs 641±387 ml) compared to the non-ERAS group. The ERAS group had significantly less total morphine-sulfate-equivalent (MSE) consumption (27±24 mg vs 42±42 mg) and used patient-controlled analgesia (PCA) (97% vs 41%) more frequently compared to the non-ERAS group. Notably, the ERAS group had a shorter time to ambulation and shorter time to removal of Foley catheters.
These data suggest that the employed ERAS protocol significantly enhances recovery trajectories and the need for analgesics in patients undergoing lumbar spinal fusion.
手术加速康复（ERAS）方案已被证明可加速各个手术领域的患者康复。关于ERAS对腰椎融合术益处的报道越来越多，但大多数依赖回顾性分析。
本研究旨在前瞻性评估ERAS方案对接受腰椎融合术患者围手术期结局的影响。
研究设计/地点：2020年11月至2023年5月在台湾台北的一家三级医疗中心进行的前瞻性比较队列研究。
该研究纳入了242例因退行性脊柱疾病接受腰椎融合术的患者，分为ERAS组和非ERAS组。
主要测量的结局包括手术时间、估计失血量（EBL）、术后恶心呕吐（PONV）、镇痛药物使用情况以及视觉模拟量表（VAS）疼痛评分。
采用倾向评分匹配（PSM）来最小化两组之间的混杂因素。连续变量采用两样本独立t检验或非参数Mann-Whitney U检验评估两组之间的差异，分类变量采用卡方检验或Fisher精确检验。
与非ERAS组相比，ERAS组的手术时间（202±68分钟对255±85分钟）和EBL（480±302毫升对641±387毫升）明显更短。与非ERAS组相比，ERAS组的总吗啡当量（MSE）消耗量明显更少（27±24毫克对42±42毫克），且更频繁地使用患者自控镇痛（PCA）（97%对41%）。值得注意的是，ERAS组的下床活动时间和拔除 Foley 导管的时间更短。
这些数据表明，所采用的ERAS方案显著改善了接受腰椎融合术患者的康复进程，并减少了镇痛药物的需求。
