The Role of Enhanced Recovery After Surgery (ERAS) Protocols in Adult Spinal Deformity Surgery: A Systematic Review and Meta-analysis

Introduction: Enhanced Recovery After Surgery (ERAS) protocols enhance recovery in various surgical fields. Goals include reducing costs, length of stay, opioid use, adverse events, and improving patient experiences. Initially utilized in other surgeries, ERAS protocols have been recently studied in spine surgeries. Research shows benefits in reduced length of stay, complication rates, readmissions, and improved pain levels, with limited studies in fusion surgeries for adult spinal deformity. This paper aims to review ERAS protocol outcomes in the surgical management of adult spinal deformity (ASD).

Methods: Based on the PRISMA guideline, a systematic search was conducted across Embase, Scopus, Web of Science, and PubMed up until September 15th, 2024, using the relevant key terms.

Results: Among 392 recruited records, eight studies met the inclusion criteria. This systematic review includes 764 patients (54.7% females) aged 22 to 73. Spinal fusion levels varied from 2.95 to 9.57 through studies with post-op follow-ups between 6 and 44 months. ERAS protocols were mostly post-op and consisted of pain management, including acetaminophen, ketorolac, dexamethasone, and epidural or intravenous analgesics. Patients using ERAS protocols had significantly lower blood loss (p = 0.01), opioid usage (p = 0.03), length of hospitalization (p = 0.00), and ambulation days after the operation (p = 0.04) than the controls. Complications (p = 0.01) and readmission rates (p = 0.01) were also reported to be significantly lower in the ERAS group. No statistically significant differences were observed regarding length of surgery (p = 0.23) and reoperation rate (p = 0.60).

Conclusion : This study underscores the positive impact of ERAS protocols in ASD surgeries, demonstrating substantial benefits in reducing blood loss, opioid consumption, hospitalization duration, and time to ambulation. The findings support ERAS as an effective approach to enhance recovery while minimizing complications and readmission rates in these complex procedures. Future research with larger sample sizes and standardized ERAS components is needed to further validate these outcomes and optimize protocol application across diverse patient populations.