Enhanced Recovery After Surgery Protocol in Patients with Adult Spinal Deformity: A Systematic Review

Introduction: Enhanced recovery after surgery (ERAS) protocols have been shown to benefit patients with adult spinal deformity (ASD). However, there is considerable variation in perioperative interventions across institutions. This study reviews the consensus on ERAS interventions for ASD surgery and evaluates the impact of ERAS protocols on postoperative outcomes.

Methods: A systematic review of PubMed and Embase was conducted following PRISMA guidelines. Studies addressing ERAS implementation for ASD corrective surgery were included. Exclusions were studies on minimally invasive surgery (MIS), decompression-only procedures, cervical deformities, reviews, case reports, conference abstracts, and editorial letters. A meta-analysis was performed on postoperative outcomes, comparing conventional care pathways (pre-ERAS) with ERAS pathways (post-ERAS) by calculating pooled standardized mean differences.

Results: Seven articles were included in the review. Common ERAS interventions included: 1) preoperative anesthesia-related risk assessment, multidisciplinary evaluation, and smoking cessation, 2) intraoperative TXA administration and continuous lab monitoring, and 3) postoperative early mobilization and nutritional support. Multimodal analgesia was frequently part of the protocols. Two studies reported reduced readmission rates and opioid consumption in the post-ERAS group compared to pre-ERAS, while three studies found comparable medical complication rates between groups. Meta-analysis showed no significant difference in length of stay (LOS) between the pre-ERAS and post-ERAS groups.

Conclusion : ERAS protocols for ASD surgery focus on preoperative optimization, intraoperative stress reduction, and postoperative recovery. While these protocols offer benefits such as reduced readmissions and opioid use, meta-analysis revealed no significant impact on LOS. Further research is needed to standardize ERAS protocols for ASD surgery and optimize postoperative outcomes.