Application of an enhanced recovery after surgery care protocol in patients undergoing lumbar interbody fusion surgery: a meta-analysis.

Abstract

Background: Enhanced recovery after surgery (ERAS) has been widely used in several surgical fields. This meta-analysis compared the clinical outcomes of the ERAS protocol and standard care (SC) in patients who underwent lumbar interbody fusion surgery.

Materials and methods: The PubMed, Web of Science, Cochrane Library, and Embase databases were systematically searched to identify studies reporting the effects of the ERAS protocol on clinical outcomes in patients who underwent lumbar interbody fusion surgery.

Results: Overall, 15 studies involving 17 865 patients were included in the final analysis. With the ERAS protocol, the length of hospitalization (SMD: - 0.47, 95% CI - 0.56 to -0.38), postoperative complications (OR = 0.62; 95% CI 0.50 to 0.77), operation time (SMD = - 0.26; 95% CI - 0.44 to -0.09), postoperative pain (SMD = - 0.35; 95% CI - 0.64 to -0.07) and duration of ambulation (SMD = - 0.80; 95% CI - 1.02 to - 0.58) were significantly reduced. The rates of readmission (OR = 0.63; 95% CI 0.38 to 1.04), estimated blood loss (SMD = - 0.31; 95% CI - 0.69 to 0.06) and hospitalization costs (SMD: - 0.56, 95% CI - 1.27 to 0.14) did not significantly differ between the ERAS and SC groups.

Conclusions: The present meta-analysis indicated that the ERAS protocol could be safely and feasibly implemented in the perioperative management of patients receiving lumbar interbody fusion surgery. The protocol significantly reduced the length of hospitalization, incidence of postoperative complications, operation time, duration of 1st ambulation and duration of postoperative pain. However, no differences were observed in estimated blood loss, readmission rates or hospitalization costs.