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Updated: Oct 26, 2025
Novel Mini-open Transforaminal Lumbar Interbody Fusion
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Enhanced Recovery Components for Posterior Lumbar Spine Fusion: Harnessing National Data to Compare Protocols
Murray Echt1,2, Jashvant Poeran2,3, Nicole Zubizarreta2,3
1Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx.
Study Design:
This was a retrospective cohort study.
Objective:
The aim of this study was to assess the most commonly used components of enhanced recovery after surgery (ERAS) combinations and their relative effectiveness.
Summary Of Background Data:
Data is lacking on use and effectiveness of various ERAS combinations which are increasingly used in spine surgery.
Materials And Methods:
Posterior lumbar fusion cases were extracted from the Premier Healthcare claims database (2006-2016). Seven commonly included components in spine ERAS protocols were identified: (1) multimodal analgesia, (2) tranexamic acid, (3) antiemetics on the day of surgery, (4) early physical therapy, (5) no urinary catheter, (6) no patient-controlled analgesia, and (7) no wound drains. Outcomes were: length of stay, "any complication," blood transfusion, and hospitalization cost. Mixed-effects models measured associations between the most common ERAS combinations and outcomes, separately for 2006-2012 and 2013-2016. Odds ratios (ORs) and 95% confidence intervals (CIs) are reported.
Results:
Among 97,419 (74%; 2006-2012) and 34,932 (26%; 2013-2016) cases ERAS component variations decreased over time. The most commonly used combinations included multimodal analgesia, antiemetics, early physical therapy, avoidance of a urinary catheter, patient-controlled analgesia and drains (10% n=9401 and 19% n=6635 in 2006-2012 and 2013-2016, respectively), and did not include tranexamic acid. Multivariable models revealed minor differences between ERAS combinations in terms of length of stay and costs. The most pronounced beneficial effects in 2006-2012 were seen for the second most commonly (compared with less often) used ERAS combination(s) in terms of blood transfusion (OR: 0.65; CI: 0.59-0.71) and "any complication" (OR: 0.73; CI: 0.66-0.80), both P<0.05. In 2013-2016 the third most commonly used ERAS combination showed the strongest effect: blood transfusion OR: 0.63; CI: 0.50-0.78, P<0.05.
Conclusions:
ERAS component variations decreased over time; maximum benefits were particularly seen in terms of transfusion and complication risk reduction. These findings may inform future ERAS utilization and clinical trials comparing various ERAS protocols.
