Approaches of Neurosurgeons and Orthopedists to the Protocol for Enhanced Recovery After Surgery (ERAS) in Spinal Pathologies: A Single Center, Survey Study

Abstract

Objective: The Enhanced Recovery After Surgery (ERAS) protocol defines multimodal interventions applied to patients during the postoperative period to enable them to return to their normal life functions as quickly as possible. It encompasses the perioperative process from the patient’s hospital admission to discharge. The aim of our study is to observe the approaches of neurosurgeons and orthopedists at our center regarding the ERAS protocol in spinal pathologies and create awareness to ensure the routine implementation of ERAS. Methods: The survey, organized according to the items of the ERAS protocol for spinal surgeries, was delivered to the participants in person or via email after obtaining approval from the local ethics committee. The survey consisted of questions aimed at investigating the approaches of surgeons regarding fundamental aspects such as anesthesia, analgesia, surgical approach, fasting-nutrition, and early mobilization during the preoperative, intraoperative, and postoperative periods of spinal surgery. Results: The survey was completed by 53 doctors, with 22 (41.5%) being neurosurgeons and 31 (58.5%) orthopedists. When evaluating the responses of the participants to the questions related to the preoperative period, it was found that patient education, blood glucose regulation for diabetic patients, preoperative skin preparation, and the use of prophylactic antibiotics and antithrombotic agents were all implemented at a rate of 100%. Regarding the choice of anesthesia method, it is noteworthy that 38.7% of orthopedists preferred regional anesthesia, while 59% of neurosurgeons opted for general anesthesia. In terms of postoperative care, the surgical teams showed a preference for removing surgical drains and urinary catheters on the first day after the surgery. As for early mobilization, 87.1% of orthopedists preferred the first postoperative day, whereas 72.7% of neurosurgeons chose the day of surgery for mobilization. Conclusion: The clinics that participated in the survey demonstrated practices that were either closely aligned or suitable to the elements constituting the ERAS protocol, even if these practices were not explicitly categorized under the ERAS heading. To ensure the widespread and accurate adoption of ERAS protocols in clinical settings, it is essential to provide the surgical teams with adequate information and encourage them to utilize ERAS principles. Keywords: Enhanced recovery after surgery, spinal procedures, orthopedic surgeon, neurosurgeon