Enhanced Recovery After Surgery (ERAS) protocols are designed to reduce the physiological stress of surgery and accelerate postoperative recovery. In this retrospective single-center study, the authors evaluated the impact of ERAS on postoperative pain, opioid consumption, and length of hospital stay among patients undergoing elective spine surgery between May 2019 and July 2020. Pain intensity was assessed using the Numerical Rating Scale (NRS), while opioid use was measured in morphine milligram equivalents (MME).

The study found that ERAS implementation did not significantly reduce overall postoperative pain scores or opioid consumption compared with traditional perioperative care. Median daily pain scores (5.55 vs. 5.28) and opioid use (17.24 vs. 16.44 MME) were similar between the ERAS and non-ERAS groups. However, patients managed under ERAS experienced a significantly shorter hospital stay, with a median of 2 days compared with 3 days for patients receiving conventional care. Subgroup analysis further demonstrated that patients undergoing anterior cervical discectomy and fusion (ACDF) benefited from lower postoperative pain scores with ERAS, whereas patients undergoing other spine procedures achieved substantially shorter hospital stays despite slightly higher reported pain levels.

These findings highlight the evolving role of ERAS pathways in spine surgery. While ERAS may not universally decrease postoperative pain or opioid requirements, it can meaningfully reduce hospital length of stay and improve recovery efficiency, particularly when tailored to specific surgical procedures. The results emphasize the importance of procedure-specific customization of ERAS protocols to maximize patient outcomes, optimize healthcare resource utilization, and maintain high-quality postoperative care.