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Enhanced Recovery After Surgery (ERAS) in Spine Surgery: A Systematic Review and Meta-Analysis of Spinal Surgery Sub - Specialities, Interventions and Efficacy

Year: 2026

Type: review

Abstract: Study Design: Systematic Review. Objectives: Enhanced Recovery After Surgery (ERAS) is a widely acknowledged approach for improving surgical outcomes. This review aims at analyzing the characteristics of study populations, interventions and outcomes in spine patients. Methods: Embase and Ovid were searched from inception until March 2025. We followed PRISMA guidelines. Study quality and risk of bias were assessed. In addition to a narrative synthesis of the evidence, a meta-analysis of RCTs evaluating length of stay (LOS) for a lumbar spine population was conducted. This review was registered prospectively on PROSPERO (No. CRD42025638293). Results: 1431 records were identified, from which 81 studies were included. Reports of ERAS predominantly exist for degenerative spine pathologies (n = 35/81, 43.2%) and spinal deformities (n = 29/81, 35.8%). Most studied interventions were postoperative analgesia, early mobilisation (both n = 61/81, 75.3%) and patient education (n = 60, 74.1%). The most frequently used outcome measures were LOS (n = 65/81, 92.9%) and complication rates (n = 40/81, 49.4%). The overall median complication rate for ERAS patients was found to be lower (8.8% vs 15.6%). There was a statistically non-significant tendency for ERAS shortening LOS for 1 day in lumbar spine patients [95%CI -2.77, 0.71; = 0.25]. Conclusions: ERAS in spine surgery appears to be effective in terms of reducing LOS and complication rates. Further efforts at refining pain management and targeted disease-specific interventions are required. Whether ERAS interventions applied to individuals with significant neurological impairment and/or medical frailty, can influence surgical outcomes needs to be further studied.

Source: Zurich Open Repository and Archive (University of Zurich)

DOI: 10.5167/uzh-282477

Authors: Büchel, Caroline, Treanor, Caroline, Davies, Benjamin, Anderson, David B, Fehlings, Michael, Zipser, Carl M, AO Spine – RECODE DCM ERAS Committee

Language: English

Topic: Enhanced Recovery After Surgery

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: green

OpenAlex ID: W7124723156

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