Effect of an enhanced recovery after surgery(ERAS) on perioperative outcomes of endoscopic lumbar interbody fusion

English Keywords:Enhanced recovery after surgery  Endoscopic lumbar interbody fusion  Opioids  Randomized controlled trial

English Abstract:

  【Abstract】 Objectives: To investigate the impact of an enhanced recovery after surgery(ERAS) on the perioperative outcomes of endoscopic lumbar interbody fusion(Endo-LIF). Methods: A single-center, randomized, single-blind(outcome assessor-blinded) controlled trial was conducted. A total of 132 consecutive patients scheduled for single-level Endo-LIF at our hospital from January 2023 to June 2024 were enrolled. Using block randomization, patients were assigned to either the ERAS group(n=66) or the control group(n=66). The control group received routine perioperative management, while the ERAS group followed a standardized ERAS pathway comprising 17 measures, including optimized anesthesia and analgesia, early oral intake, early ambulation, and complication prevention. Perioperative outcomes including postoperative 24h opioid consumption(calculated as oral morphine equivalents, OME), Quality of Recovery-40(QoR-40) scores on postoperative 3d, length of stay(LOS), duration of intravenous patient-controlled analgesia(IV-PCA) use, Oswestry disability index(ODI) at 2 weeks and 3 months postoperatively, the visual analogue scale (VAS) pain score, and postoperative complications within 30d were recorded. Results: There were no statistically significant differences in baseline characteristics such as gender, age, body mass index(BMI), surgical level, and perioperative risk stratification between the two groups(P>0.05). Compared with the control group, the ERAS group showed significantly lower postoperative 24h OME[70(45-94)mg vs 127(82-178)mg, P=0.030] and significantly shorter duration of IV-PCA use(25±6h vs 36±8h, P<0.001). The LOS in the ERAS group was significantly shorter than that in the control group(6.8±1.7d vs 10.3±2.6d, P<0.001). On postoperative 3d, the QoR-40 score in the ERAS group was higher than that in the control group(179±14 vs 170±16, P<0.001). Regarding functional recovery, the improvement in ODI at 2 weeks postoperatively was superior in the ERAS group(P<0.001), while no significant difference was observed at 3 months(P=0.261). There was no significant difference in the incidence of complications within 30d postoperatively between the two groups(P>0.05), and the main complications included hematoma, urinary retention and infection, which were cured after conservative treatment without secondary surgeries or unplanned readmissions. Conclusions: The ERAS approach based on 17 measures is safe and feasible for patients undergoing Endo-LIF. It significantly reduces perioperative opioid consumption, improves early subjective quality of recovery, and shortens LOS.