Enhanced Clinical Outcomes in Frail Patients Who Underwent Short Lumbar Fusion Surgery With the Implementation of the Enhanced Recovery After Surgery (ERAS) Protocol

Abstract

Background: Frailty among surgical patients correlates with the risks of adverse outcomes, including postoperative complications, extended recovery, and elevated mortality rates. The ERAS protocol is a comprehensive, team-based care pathway that focuses on refining perioperative management, lowering the risk of complications, and promoting faster recovery. This study investigates the effects of implementing ERAS on hospitalization duration, clinical outcomes, and perioperative complications in frail individuals undergoing short-segment lumbar fusion. Methods: We included frail patients ≥65 years who underwent one- or two-level posterior lumbar fusion for degenerative spinal disease from January 2018 to October 2020 (non-ERAS cohort) and from October 2020 to June 2023 (ERAS cohort). Demographic information, comorbidities, and surgical details were collected. The primary outcome was to compare the hospitalization duration. Additionally, other clinical outcomes, such as postoperative recovery parameters, pain scores, complications, and the Oswestry Disability Index (ODI), were recorded. Results: The study enrolled 114 frail patients, equally distributed into ERAS and non-ERAS cohorts. ERAS intervention significantly reduced the length of hospital stay (6.95 ± 2.74 days vs. 8.72 ± 4.54 days, p = 0.024) and blood transfusion rates (19.3% vs. 49.1%, p = 0.001). Time to remove the drain and indwelling catheter showed no statistically significant difference. Postoperative VAS scores and Oswestry Disability Index (ODI) scores at 6-week, 6-month, and 12-month follow-up intervals were comparable between groups. There was no significant difference in the incidence of major or minor complications between the two groups. Conclusions: Our study suggests that applying an ERAS pathway to frail individuals undergoing short-segment lumbar fusion can shorten hospital stay and lower transfusion rates, while not increasing complications, reoperations, or readmissions.