Enhanced Recovery After Surgery (ERAS) protocols have transformed perioperative care across multiple specialties. While their benefits are well established in abdominal surgery, their role in spine surgery is still evolving.

In our recent study published in Clinical Neurology and Neurosurgery, we explored the impact of ERAS on postoperative pain, opioid consumption, and length of stay in elective spine procedures.

🔎 Study Overview

• Single-center retrospective study
• Patients undergoing elective spine surgery (2019–2020)
• Comparison: ERAS pathway vs. traditional care
• Outcomes assessed:
  • Pain scores (Numerical Rating Scale, NRS)
  • Opioid consumption (morphine milligram equivalents, MME)
  • Length of stay (LOS)

📊 Key Findings

• Pain scores (NRS)
 – No significant difference between ERAS and non-ERAS groups

• Opioid consumption (MME)
 – Similar between both groups

• Length of stay (LOS)
 – Significantly shorter with ERAS
 – Median: 2 days (ERAS) vs. 3 days (non-ERAS)

• Procedure-specific effects
 – ERAS patients undergoing ACDF had lower pain scores
 – In other spine procedures, ERAS showed shorter LOS but slightly higher pain scores

💡 Clinical Takeaway

While ERAS protocols did not significantly reduce overall pain scores or opioid consumption, they were associated with a meaningful reduction in hospital length of stay.

Importantly, the impact of ERAS appears to be procedure-dependent, highlighting the need for tailored implementation rather than a one-size-fits-all approach.

⚖️ What This Means for Practice

• ERAS can improve efficiency and resource utilization in spine surgery
• Benefits may vary depending on procedure type (e.g., ACDF vs. others)
• Careful balancing of early discharge and pain control remains essential

This study reinforces that ERAS is not a static protocol—but a dynamic, adaptable framework that should be refined based on surgical context and patient needs.

📄 The impact of enhanced recovery after surgery (ERAS) on opioid consumption and postoperative pain levels in elective spine surgery
Clinical Neurology and Neurosurgery (2024)
DOI: 10.1016/j.clineuro.2024.108350

Eloise Stanton, Zorica Buser, Mohamed Kamal Mesregah, Kelly Hu, Trevor A Pickering, Betsy Schafer, Raymond Hah, Patrick Hsieh, Jeffrey C Wang, John C Liu

Article links:

https://pubmed.ncbi.nlm.nih.gov/38788543/

https://www.sciencedirect.com/science/article/abs/pii/S0303846724002373

I’d be interested to hear your perspective:

• Have you implemented ERAS protocols in spine surgery?
• Have you observed reductions in LOS without compromising pain control?
• Do you tailor ERAS pathways by procedure type?