Pathway for Enhanced Recovery After Spinal Surgery

A Systematic Review of Evidence for Use of Individual Components

Ana Licina; Andrew Silvers; Harry Laughlin; Jeremy Russell; Crispin Wan


BMC Anesthesiol. 2021;21(74) 

In This Article


Enhanced recovery after surgery (ERAS) programs have demonstrated improvements in outcomes. Improvements have been demonstrated in recovery, functional measures, lower morbidity, decreased length of stay with healthcare cost savings.[1,2] The disease burden of spinal pathologies is high.[3] Between 2004 to 2015, there has been an increase in volume of elective lumbar fusion accompanied by increased hospital costs.[4] Limited enhanced recovery pathways have been applied to spinal surgery. A consistent feature is a uniform finding of decreased length of stay.[5–8] There was a notable decrease in the adverse events during hospital stay.[8,9]

There is a need to apply lessons learned from enhanced recovery programs in other surgical specialties to surgery of the spine.[10] Prior narrative qualitative reviews have delineated recommendations for the incorporation of individual components into an enhanced recovery after spinal surgery (ERSS) program. Several critical components of enhanced recovery in spinal surgery have been identified. These include: provision of comprehensive perioperative nutrition, multimodal analgesia, minimally invasive surgery where clinically feasible and early mobilization.[10,11] Individual ERSS programs differ substantially.[12] Our group of authors have identified and proposed the first comprehensive program of Enhanced Recovery in Spinal Surgery (Table 1),.[11] We defined the individual components based on the enhanced recovery protocols in other surgical subspecialties and prior qualitative reviews of ERAS in spinal surgery.[1,12–20]

The aim of this study was to systematically evaluate pre-defined individual components of an ERSS pathway (program). We planed to create an evidence-based assessment of the available literature for each pre-defined component of an ERSS program.[21] Formulating the evidence base for each component, would strengthen the quality of ERSS programs. Consistency with regards to best practice in ERSS, would allow for standardization of care pathways. Greater standardization of care pathways results in improved external validity across comparative research.