Optimising postoperative spine outcomes: an umbrella review of enhanced recovery after spinal surgery (ERASS) protocols

作者：Daniel Sescu, Devika Dahiya, Laura Scaramuzzo, Stipe Ćorluka, Sathish Muthu, Samuel K. Cho, Zorica Buser, S. Tim Yoon, Andreas K. Demetriades · 发表于：British Journal of Anaesthesia · 年份：2025 · DOI：10.1016/j.bja.2025.08.037 · 被引用次数：7 · 研究领域：Enhanced Recovery After Surgery、Anesthesia and Pain Management、Nausea and vomiting management

BACKGROUND: Enhanced Recovery After Surgery (ERAS) protocols aim to improve recovery, reduce complications, and optimise surgical outcomes. Despite increasing use in spinal surgery, no standardised ERAS for spinal surgery (ERASS) exists and evidence synthesis is limited. This umbrella review consolidates findings from systematic reviews (SRs) and meta-analyses (MAs) to evaluate the clinical and economic impact of ERASS and identify research gaps. METHODS: A systematic search of MEDLINE, Embase, Cochrane Database of Systematic Reviews, and Web of Science (1990-2024) identified SRs and MAs on ERASS. Data extraction followed Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and Preferred Reporting Items for Overviews of Reviews (PRIOR), with quality assessed using AMSTAR-2 and ROBIS. Overlapping primary studies were removed before recalculating pooled estimates using fixed or random-effects models based on heterogeneity. Primary outcomes included length of stay, postoperative complications, readmission rates, healthcare costs, pain scores, and opioid consumption. RESULTS: Seventeen SRs and 55 MAs (319 primary studies; n=221 605 participants) were included. ERASS significantly reduced length of stay (-1.55 days; 95% confidence interval [CI] -1.83 to -1.27 days; P<0.01), postoperative complications (relative risk=0.61; 95% CI 0.52-0.72; P<0.01), opioid consumption (-7.26 mg morphine equivalents; 95% CI -10.82 to -3.70 mg; P<0.01), and healthcare costs (-$...