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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
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.
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.
