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Fast-track protocols for patients undergoing spine surgery: a systematic review.

Deyanira Contartese1, Francesca Salamanna2, Silvia Brogini1

  • 1Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, 40136, Bologna, Italy.

BMC Musculoskeletal Disorders
|January 22, 2023
PubMed
Summary

Fast-track protocols enhance recovery in spine surgery by reducing hospital stays and opioid use. Further randomized trials are needed to confirm benefits across all patient groups.

Keywords:
Fast-trackIntra- and postoperative elementsLengths of stayPainPre-Spine surgery

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Area of Science:

  • Orthopedic Surgery
  • Evidence-Based Medicine
  • Patient Recovery Pathways

Background:

  • Fast-track is an evidence-based strategy for perioperative management, yet its adoption in orthopedic spine surgery is limited.
  • Enhanced recovery pathways represent a novel approach in this surgical field.

Purpose of the Study:

  • To conduct an evidence-based assessment of interventions and outcomes associated with enhanced recovery pathways in spine surgery.
  • To evaluate the clinical evidence supporting fast-track protocols in spine surgery.

Main Methods:

  • Systematic review of 3 databases (February 2012 - August 2022).
  • Assessment of pre-, intra-, and postoperative elements of fast-track protocols in spine surgery patients.
  • Inclusion of 57 full-text articles, predominantly retrospective.

Main Results:

  • Common fast-track elements include patient education, multimodal analgesia, prophylaxis, early catheter/drain removal, and early mobilization/nutrition.
  • Interventions significantly reduced length of stay (LOS) and opioid consumption.
  • Improved pain scores, patient satisfaction, and functional recovery without increased complications or readmissions were observed.

Conclusions:

  • Fast-track protocols effectively reduce LOS, accelerate functional recovery, minimize pain, and lower costs in spine surgery.
  • Current evidence is largely based on retrospective studies of degenerative spine diseases.
  • Multicenter randomized trials are essential to validate fast-track benefits and implementation in spine surgery.