Postoperative Outcomes in Patients with Metastatic Spine Tumors Using an Enhanced Recovery After Surgery Program: A Systematic Review and Meta-Analysis
Research Fellow University of North Carolina at Chapel Hill Chapel Hill, NC, US
Introduction: Patients with metastatic spine tumors often undergo complex surgeries that can significantly impact their postoperative recovery and quality of life. Enhanced recovery after surgery (ERAS) program have been developed to accelerate recovery and improve outcomes by integrating multidisciplinary care protocols showing efficacy in various surgical specialties. Still, their impact on the outcomes of surgeries for metastatic spine tumors remains unknown. We aimed to evaluate the impact of the ERAS program on postoperative outcomes in patients undergoing surgery for metastatic spine tumors.
Methods: PubMed, EMBASE, and CENTRAL databases were searched following the PRISMA guidelines for randomized trials and observational studies published up to September 2024. A random-effects meta-analysis was estimated using R version 4.4.0 to calculate mean differences (MD) and relative risks (RR). The outcomes assessed were length of hospital stay (LOS), complication rates, and patient recovery.
Results: Four studies with 972 patients were included. ERAS group significantly reduced the LOS by an MD of 2.62 days (95% CI = −3.08 to −2.17, p< 0.01, Fig. 1A), improved the return to a regular diet by 12.94 hours (95% CI = −16.26 to −9.62, p< 0.01, Fig. 1B), and facilitated earlier removal of the urinary catheter by 30.69 hours (95% CI = −37.36 to −24.01, p< 0.01, Fig. 1C). The risk of complications was significantly lower in patients managed with ERAS (RR: 0.54, 95% CI = 0.33 to 0.88, p=0.03, Fig. 2A). The time to ambulation was also significantly reduced, with patients ambulating in 33.86 hours (95% CI = −57.77 to −9.94, p=0.03, Fig. 2B).
Conclusion : Our findings support the implementation of the ERAS program in the management of patients with metastatic spine tumors, emphasizing the improvement in clinical outcomes and optimizing resource utilization in surgical care.