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Consensus statement for perioperative care in lumbar spinal fusion: Enhanced Recovery After Surgery (ERAS®) Society recommendations
Paris-Versailles Spine Center (Centre Francilien du Dos), Paris, France; Ramsay Santé-Hôpital Privé de Versailles, Versailles, France.
Research Institute, Bournemouth University, Bournemouth, UK; The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, Bournemouth, UK.
Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA.
Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden.ORCID iD: 0000-0002-7376-4664
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2021 (English)In: The spine journal, ISSN 1529-9430, E-ISSN 1878-1632, Vol. 21, no 5, p. 729-752Article, review/survey (Refereed) Published
Abstract [en]

BACKGROUND: Enhanced Recovery After Surgery (ERAS) evidence-based protocols for perioperative care have led to improvements in outcomes in numerous surgical areas, through multimodal optimization of patient pathway, reduction of complications, improved patient experience and reduction in the length of stay. ERAS represent a relatively new paradigm in spine surgery.

PURPOSE: This multidisciplinary consensus review summarizes the literature and proposes recommendations for the perioperative care of patients undergoing lumbar fusion surgery with an ERAS program.

STUDY DESIGN: This is a review article.

METHODS: Under the impetus of the ERAS (R) society, a multidisciplinary guideline development group was constituted by bringing together international experts involved in the practice of ERAS and spine surgery. This group identified 22 ERAS items for lumbar fusion. A systematic search in the English language was performed in MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. Systematic reviews, randomized controlled trials, and cohort studies were included, and the evidence was graded according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Consensus recommendation was reached by the group after a critical appraisal of the literature.

RESULTS: Two hundred fifty-six articles were included to develop the consensus statements for 22 ERAS items; one ERAS item (prehabilitation) was excluded from the final summary due to very poor quality and conflicting evidence in lumbar spinal fusion. From these remaining 21 ERAS items, 28 recommendations were included. All recommendations on ERAS protocol items are based on the best available evidence. These included nine preoperative, eleven intraoperative, and six postoperative recommendations. They span topics from preoperative patient education and nutritional evaluation, intraoperative anesthetic and surgical techniques, and postoperative multi-modal analgesic strategies. The level of evidence for the use of each recommendation is presented.

CONCLUSION: Based on the best evidence available for each ERAS item within the multidisciplinary perioperative care pathways, the ERAS (R) Society presents this comprehensive consensus review for perioperative care in lumbar fusion.

Place, publisher, year, edition, pages
Elsevier, 2021. Vol. 21, no 5, p. 729-752
Keywords [en]
Enhanced recovery after surgery, Perioperative care, Fast-track surgery, ERAS, Spine surgery, Lumbar fusion, Minimally invasive spine surgery, Degenerative spine disease, Evidence-based recommendations
National Category
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-88536DOI: 10.1016/j.spinee.2021.01.001ISI: 000649672700001PubMedID: 33444664Scopus ID: 2-s2.0-85100084807OAI: oai:DiVA.org:oru-88536DiVA, id: diva2:1518984
Available from: 2021-01-18 Created: 2021-01-18 Last updated: 2023-05-23Bibliographically approved

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Sigmundsson, Freyr GautiLjungqvist, Olle

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