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Research ArticleOther and Special Categories

Enhanced Recovery After Surgery Trends in Adult Spine Surgery: A Systematic Review

Yixuan Tong, Laviel Fernandez, John A. Bendo and Jeffrey M. Spivak
International Journal of Spine Surgery July 2020, 7083; DOI: https://doi.org/10.14444/7083
Yixuan Tong
1New York University Grossman School of Medicine, New York, New York
BA
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Laviel Fernandez
2Spine Division, New York University Langone Orthopedic Hospital, New York, New York
MD
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John A. Bendo
2Spine Division, New York University Langone Orthopedic Hospital, New York, New York
MD
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Jeffrey M. Spivak
2Spine Division, New York University Langone Orthopedic Hospital, New York, New York
MD
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ABSTRACT

Background Enhanced Recovery After Surgery (ERAS) is a multimodal, multidisciplinary approach to optimizing the postsurgical recovery process through preoperative, perioperative, and postoperative interventions. ERAS protocols are emerging quickly within orthopaedic spine surgery, yet there is a lack of consensus on optimal ERAS practices.

Objective The aim of this systematic review is to identify and discuss the trends in spine ERAS protocols and the associated outcomes.

Methods A literature search on PubMed was conducted to identify clinical studies that implemented ERAS protocols for various spine procedures in the adult population. The search included English-language literature published through December 2019. Additional sources were retrieved from the reference lists of key studies. Studies that met inclusion criteria were identified manually. Data regarding the study population, study design, spine procedures, ERAS interventions, and associated outcome metrics were extracted from each study that met inclusion criteria.

Results Of the 106 studies identified from the literature search, 22 studies met inclusion criteria. From the ERAS protocols in these studies, common preoperative elements include patient education and modified preoperative nutrition regimens. Perioperative elements include multimodal analgesia and minimally invasive surgery. Postoperative elements include multimodal pain management and early mobilization/rehabilitation/nutrition regimens. Outcomes from ERAS implementation include significant reductions in length of stay, cost, and opioid consumption. Although these trends were observed, there remained great variability among the ERAS protocols, as well as in the reported outcomes.

Conclusions ERAS may improve cost-effectiveness to varying degrees for spinal procedures. Specifically, the use of multimodal analgesia may reduce overall opioid consumption. However, the benefits of ERAS likely will vary based on the specific procedure.

Clinical Relevance This review contributes to the assessment of ERAS protocol implementation in the field of adult spine surgery.

  • Enhanced Recovery After Surgery
  • ERAS
  • fast-track surgery
  • rapid recovery program
  • spine surgery
  • orthopedics
  • multimodal analgesia

Footnotes

  • Disclosures and COI: The authors received no funding for this study and report no conflicts of interest.

  • ©International Society for the Advancement of Spine Surgery
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International Journal of Spine Surgery: 19 (S2)
International Journal of Spine Surgery
Vol. 19, Issue S2
1 Apr 2025
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Enhanced Recovery After Surgery Trends in Adult Spine Surgery: A Systematic Review
Yixuan Tong, Laviel Fernandez, John A. Bendo, Jeffrey M. Spivak
International Journal of Spine Surgery Jul 2020, 7083; DOI: 10.14444/7083

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Enhanced Recovery After Surgery Trends in Adult Spine Surgery: A Systematic Review
Yixuan Tong, Laviel Fernandez, John A. Bendo, Jeffrey M. Spivak
International Journal of Spine Surgery Jul 2020, 7083; DOI: 10.14444/7083
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Keywords

  • Enhanced Recovery After Surgery
  • ERAS
  • fast-track surgery
  • rapid recovery program
  • spine surgery
  • orthopedics
  • multimodal analgesia

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