ERAS protocol for anterior/oblique lumbar fusion reduces postoperative length of stay without worsening outcomes.

Metadata-grounded summary

Citation abstract

BACKGROUND: Anterior and oblique lumbar interbody fusion combined with enhanced recovery protocols, has gained prominence for optimizing patient outcomes, including reduced postoperative length of stay (PLOS). The approval of anorganic bone graft substitute like P-15/ABM, which reduce complications associated with autologous graft harvesting, further supports these approaches. However, the impact of these strategies on clinical outcomes, particularly in reducing PLOS and complications, remains unclear. This study addresses: Does combining enhanced recovery protocols with anorganic bone graft substitute reduce PLOS following anterior or oblique lumbar fusion? Are shorter hospital stays associated with worsened clinical outcomes?

HYPOTHESIS: We hypothesize that integrating enhanced recovery protocols and an anorganic bone graft substitute reduces PLOS without increasing early complications.

PATIENTS AND METHODS: This retrospective, single-center cohort study included 123 patients who underwent anterior or oblique lumbar interbody fusion between 2020 and 2022. Patients were categorized by PLOS: < 1 day (n = 85) and ≥ 2 days (n = 38). Clinical outcomes included pain (visual analogic scale for low back and radicular pain), functional disability (Oswestry Disability Index), quality of life (12-item Short Form Health Survey, physical and mental component scores), and complications. Statistical analyses compared outcomes across subgroups and assessed associations with PLOS.

RESULTS: The mean PLOS was 39.2 ± 26.9 h (1.6 ± 1.1 days), significantly lower than reported averages for similar procedures. Pain and quality of life improved significantly in all patients over time (p < 0.0001), with no significant subgroup differences at 36 months (VAS-LB: 3.78 ± 3.46 vs. 3.29 ± 2.87, p = 0.11; SF-12 PCS: 37.31 ± 8.26 vs. 46.81 ± 11.25, p = 0.78). ODI trajectories differed, with slower recovery in the ≥2 days group at 36 months (p < 0.001). A greater reliance on level 3 analgesics was observed in the ≥ 2 days group (25.7% [9/35] vs. 9.4% [7/74], p = 0.04). Overall complication rates were consistent across subgroups (21% [8/38] vs. 21% [18/85] p = 1).

CONCLUSION: Combining enhanced recovery protocols with an anorganic bone graft substitute is associated with reduced PLOS and favorable clinical outcomes. Prolonged hospitalization correlated with greater opioid use and slower functional recovery, highlighting the need for tailored management. These results align with prior studies and underscore the importance of granular analyses to evaluate patient-specific factors influencing recovery.

LEVEL OF EVIDENCE: IV; Retrospective cohort study.