How Much Benefit Can Patients Acquire from Enhanced Recovery After Surgery Protocols with Percutaneous Endoscopic Lumbar Interbody Fusion?

Figures & data

Table 1 Lumbar Degenerative Disease Types

Diagnosis	Pre-ERAS (n = 45)	ERAS (n = 46)	p value
Degenerative spondylolisthesis	24	23	0.750
Lumbar spinal canal stenosis	8	5
Segmental instability	5	7
Recurrent lumbar disc herniation	3	5
Lumbar discogenic pain	3	5
Isthmic spondylolisthesis	2	1

Table 2 Items Included in pre-ERAS and Post-ERAS Care

	Pre-ERAS	Post-ERAS
Patient education	Basic information on surgery without ERAS education	ERAS education and setting goals for pain management, mobilization, discharge planning, and the role of the patient in recovery.
Nutritional assessment	No assessment and intervention	The nutritional status of patients was assessed, and nutritional support was administered if necessary.
Pre-emptive analgesia	Not conventionally used	Celecoxib, eperisone, extended-release tramadol, and pregabalin were used on the day of admission according to the condition of the patient.
Preoperative fasting Carbohydrate loading	Fasting for 12 hours before surgery	Four hours for liquids and 6 hours for solids; clear carbohydrate-rich drink was provided 4 hours preoperatively
Antimicrobial prophylaxis	Not performed at a consistent time	Cefuroxime (1.5 g) was administered proactively 30 minutes before incision
Wound local anesthetic	No local anesthetic at wound	Skin blocks using local anesthesia were routinely performed around the skin incision
Normothermia maintenance	Using blankets	Air-warming device and warmed intravenous fluids were used to keep core temperature >36°C
Normovolemia maintenance	Caregiver preference	Goal-directed fluid therapy was performed
Pre-emptive multimodal analgesia	Caregiver preference	Intravenous parecoxib was used immediately after surgery, and oral pain medications (celecoxib, acetaminophen, and, if necessary, pregabalin) were administered from POD 1
Early nutrition	Not provided clear liquids on POD 0	Eat liquid food on POD 0 and switched to eating solid food on POD 1
Early catheter and drain removal	Removal at POD 2 or POD 3	Catheter and drain removal on POD 1
Postoperative mobilization	Patients are required to bed rest on POD 1	Patients are encouraged to get out of bed on POD 1 using a brace

Abbreviations: ERAS, enhanced recovery after surgery; POD, postoperative day.

Table 3 Patient Demographics

Variable	Pre-ERAS (n = 45)	ERAS (n = 46)	p value
Gender			0.466
Male	19	16
Female	26	30
Age, years	56.8±8.9	55.2±10.8	0.417
BMI, kg/m2	24.7±2.8	25.2±3.3	0.363
Preoperative pain score	5.2±1.6	4.7±1.6	0.133
Medical comorbidities
Hypertension, n	5	6	0.777
Diabetes mellitus, n	3	3	1.000
Coronary artery disease, n	0	1	1.000
COPD, n	1	1	1.000
Asthma, n	0	1	1.000
Liver disease, n	0	3	0.242

Table 4 Intraoperative and Postoperative Variables

	Pre-ERAS (n = 45)	ERAS (n = 46)	p value
Surgical duration, minutes	137.6±32.3	134.7±28.4	0.654
Volume of intraoperative blood loss, mL	50 (20–180)	47 (30–150)	0.788
Surgical level			0.203
One level	41	45
Two levels	4	1
VAS score
Postoperative day 0	2.1±0.6	1.8±0.7	0.064
Postoperative day 1	2.6±0.7	2.0±0.6	<0.001
Postoperative surgical dram drainage, mL	40(20–80)	37(20–70)	0.678
Complications, n	2	2	1.000
Morphine equivalents, mg	33.3(15–99.7)	25.0(0–66.5)	0.017
Hospital LOS, days	3.4±0.6	3.1±0.7	0.096
Hospital cost, dollar	10,598.6±1572.0	10,384.5±1210.5	0.468
30-day readmission, n	2	0	0.242