Impact of Enhanced Recovery After Surgery in Minimally Invasive Spine Surgery

Introduction: Enhanced recovery after surgery protocols have been used to improve patient outcomes in spine surgery. The extent it has improved outcomes has yet to be determined and can help guide postoperative protocols.

Methods: Adult lumbar patients with complete 2-year(2Y) postoperative radiographic/HRQL data were stratified by enrollment in ERAS(E) beginning in 2019. Multivariate regression was used to assess differences.

Results: 387 met inclusion criteria. 193 patients had ERAS protocol while 150 did not, with age and baseline disability in mobility being greater in ERAS cohort(p <.05). Greater baseline deformity was present in E cohort. Operative time was lower in E (p <.001), with less SICU admissions, and decreased length of stay. E cohort presented with more back pain at baseline (NRS-Back 8.28 vs 7.16, p=.001), and had no difference in pain immediately postoperatively, yet by 3Mo presented with less back pain. No difference in baseline leg pain between ERAS and NE, yet leg pain was significantly improved perioperatively till 6 months post op (p <.044), with no difference in leg pain between groups thereafter. This translated to lower opioid usage from baseline till 1 year for E with better. Controlling for levels fused, E group had significantly higher distance ambulated postoperatively(165ft vs 85ft, p<.001). MCID rates were higher at 3 months in E, however after 6 months rates of MCID were similar. Multivariate regression controlling for baseline characteristics depicted those that had ERAS to be 5.3x more likely to achieve MCID by 6-months(p=0.016).

Conclusion : Our study has shown that ERAS leads to an improved postoperative course with greater improvement in pain, which resulted in lower opioid use and return to baseline.