Establishment and Implementation of an Enhanced Recovery After Surgery (ERAS) Pathway Tailored for Minimally Invasive Transforaminal Lumbar Interbody Fusion Surgery

PURPOSE: The concept of enhanced recovery after surgery (ERAS) spread to different surgical specialties to minimize surgical stress response and to reduce length of hospital stay (LOS) and cost. Recently, several studies have reported experience with the ERAS program for spine surgery. The aim of this study is to introduce the establishment and implementation of the ERAS pathway for minimally invasive surgery (MIS) transforaminal lumbar interbody fusion (TLIF). METHODS: A multidisciplinary ERAS team was created to develop and implement a multimodal and evidence-based ERAS protocol for patients undergoing MIS-TLIF at a single spine center from January 2018. Fourty four cases in the ERAS group were compared with a historical cohort of 30 cases (from January 2017 to December 2017) who underwent MIS-TLIF before the pathway implementation (pre-ERAS group). We reviewed the compliance with ERAS components. The primary outcome was LOS. The secondary outcomes included 30-day readmission rate, 30-day reoperation rate, and financial cost. Perioperative factors and perioperative complications were also assessed. RESULTS: The protocol was composed of 11 ERAS components. The ERAS group showed high compliance with the ERAS program. The ERAS group manifested shorter LOS and lower cost compared with the the pre-ERAS group. There were no significant differences in complication rate, 30-day readmission and reoperation rates. Furthermore, the blood loss, operative time, intraoperative fluid infusion and postoperative drainage of the ERAS group decreased. CONCLUSIONS: Our ERAS program tailored for MIS-TLIF is able to reduce LOS and cost with minimal complications. The ERAS pathway expedites recovery in patients undergoing lumbar spine fusion.