Enhanced Recovery After Surgery (ERAS) Program for Elderly Patients With Long-level Lumbar Fusion

Background: Currently, ERAS for spinal surgery field is still in its beginnings, the major protocol lessons learned from other surgical specialties and lack of ERAS program for elderly patients (>70 years old). Geriatric patients has its own special characteristics resulting in more harmed by surgical stress. The enhanced recovery after surgery (ERAS) are designed to improving recovery after surgery and can result in substantial benefits in both clinical outcomes and cost-effectiveness. In the present study, we aimed to determine whether enhanced recovery after surgery (ERAS) significantly improved satisfaction and outcomes in elderly patients (>70 years old) with long-level lumbar fusion. Methods: A total of 144 patients were included, 62 in the ERAS group and 82 case-matched patients in the non-ERAS group. Data including demographic, comorbidity and surgical information were collected from electronic medical records. ERAS interventions were categorised as preoperative, intraoperative and postoperative. We also evaluated primary outcome, surgical complication and length of stay (LOS).Results: There were no statistically significant intergroup differences in regards to demographics, comorbidities、American Society of Anaesthesiologists (ASA) grade、or the number of fusion levels. There were also no differences between mean surgery time of intraoperative blood loss between the ERAS and non-ERAS groups. In addition, the mean preoperative Visual Analogue Score (VAS) for the back and legs and Oswestry Disability Index (ODI) score were not significantly different between the two groups. Overall, ERAS pathway compliance was 91.5%. There were no significant differences in the mortality rates between the ERAS and non-ERAS groups. However, we observed a statistically significant decrease in the complications in the ERAS group(6 in the ERAS group versus 23 in the non-ERAS group, p=0.006) and LOS in the ERAS group (17.74±5.56 of ERAS group versus 22.13±12.21 in non-ERAS group, p=0.041). Multivariable linear regression showed that comorbidities (p=0.028) and implementation of ERAS program (p=0.002) were correlated with prolonged LOS. Multivariable logistic regression showed that comorbidities (p=0.029)， implementation of ERAS program (p=0.043) and preoperative VAS Back (p=0.046), were correlated with complications. Conclusions: This report describes the first ERAS protocol used in elderly patients after long-level lumbar fusion surgery. Our ERAS program is safe and could help decreases LOS and complication in elderly patients with long-level lumbar fusion.