Does Enhanced Recovery After Surgery (ERAS) Make a Difference in Endoscopic Spine Surgery Outcomes? A Systematic Review and Meta-Analysis

Introduction: Endoscopic spine surgery (ESS) is a minimally invasive approach that poses unique perioperative management challenges. Enhanced recovery after surgery (ERAS) protocols have been developed to improve patient outcomes by optimizing perioperative care. However, the role of ERAS in ESS remains unclear. This meta-analysis evaluates what benefit ERAS provides to the already minimally invasive ESS.

Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. The protocol was registered with PROSPERO (CRD42024587076). Studies comparing ERAS protocols with traditional care in ESS for degenerative lumbar conditions were included. The Newcastle-Ottawa Scale and Cochrane Risk of Bias tools assessed study quality. Length of stay (LOS) was the primary outcome, while secondary outcomes assessed operative time, estimated blood loss (EBL), Oswestry Disability Index (ODI), visual analog scale (VAS), and complication incidence. Statistical analysis was performed using R Studio.

Results: Five studies were analyzed, including 709 patients (4 cohort studies and 1 randomized controlled trial). ERAS + ESS significantly reduced LOS (SMD = -1.68, 95% CI [-3.06, -0.31], I² = 97%, p < 0.01) and complication rates (RR = 0.31, 95% CI [0.04, 2.46], I² = 66%). Compared to the non-ERAS group, the ERAS group had lower back VAS (SMD = -0.78, 95% CI [-0.96, -0.60], I² = 87%) and ODI (SMD = -0.35, 95% CI [-0.55, -0.15], I² = 0%) scores immediate post-op, although these differences were not observed at final follow-up. No significant differences were found for operative time or EBL. The quality assessment indicated that the included studies were moderate to high quality.

Conclusion : ERAS in ESS is associated with reduced LOS, fewer complications, and improved short-term pain and disability outcomes. These results suggest ERAS protocols provide meaningful benefits even in minimally invasive procedures like ESS. Further high-quality studies are needed to refine ERAS protocols for ESS and explore their broader adoption.