Enhanced recovery after surgery (ERAS) program for elderly patients with short-level lumbar fusion
Authors: Wang Peng , Wang Qiang , Kong Chao , Teng Ze , Li Zhongen , Zhang Sitao , Sun Wenzhi , Feng Mingli , Lu Shibao 
Published: June 2020

Abstract
Background: Degenerative disorders of the lumbar spine decrease the mobility and quality of life of elderly patients. Lumbar fusion surgery is the primary method of treating degenerative lumbar spine disorders; however, the surgical stress response associated with major surgery has been linked to pathophysiological changes in the elderly, resulting in undesirable postoperative morbidity, complications, pain, fatigue, and extended convalescence. In the present study, we aimed to determine whether enhanced recovery after surgery significantly improved satisfaction and outcomes in elderly patients (>65 years old) with short-level lumbar fusion. Methods: A total of 192 patients were included, 96 in the enhanced recovery after surgery group and 96 case-matched patients in the non- enhanced recovery after surgery group. Data including demographic, comorbidity and surgical information were collected from electronic medical records. enhanced recovery after surgery interventions were categorised as preoperative, intraoperative and postoperative. We also evaluated primary outcome, surgical complication, length of stay, postoperative pain scores and 30-day readmission rates. Results: There were no statistically significant intergroup differences in regards to demographics, comorbidities、American Society of Anaesthesiologists grade、or the number of fusion levels. There were also no differences between mean surgery time of intraoperative blood loss between the enhanced recovery after surgery and non- enhanced recovery after surgery groups. In addition, the mean preoperative Japanese Orthopaedic Association score、Visual Analogue Score for the back and legs and Oswestry Disability Index score were not significantly different between the two groups. Overall, enhanced recovery after surgery pathway compliance was 92.1%. There were no significant differences in the number of complications or the mortality rates between the enhanced recovery after surgery and non- enhanced recovery after surgery groups. Furthermore, the mean postoperative Japanese Orthopaedic Association score、Visual Analogue Score for the back and legs, Oswestry Disability Index score and readmission rates score revealed no significant differences between the groups at 30-day- follow-up point. However, we observed a statistically significant decrease in length of stay in the enhanced recovery after surgery group (12.30±3.03 of enhanced recovery after surgery group versus 15.50±1.88 in non- enhanced recovery after surgery group, p=0). Multivariable linear regression showed that comorbidities (p=0.023) and implementation of enhanced recovery after surgery program (p=0.002) were correlated with prolonged length of stay. Multivariable logistic regression showed that no characteristics were associated with complications. Conclusions: This report describes the first enhanced recovery after surgery protocol used in elderly patients after short-level lumbar fusion surgery. Our enhanced recovery after surgery program is safe and could help decreases length of stay in elderly patients with short-level lumbar fusion.