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Enhanced Recovery After Surgery Pathways in Pediatric Spinal Surgery: A Systematic Review and Meta-Analysis
Grace Hey1, Yusuf Mehkri1, Ilyas Mehkri1
1University of Florida College of Medicine, Gainesville, Florida, USA.
Insights
Enhanced recovery after surgery (ERAS) protocols significantly reduce hospital stay, pain, and complications in pediatric spinal fusion patients. This evidence-based approach optimizes care and shows potential for cost savings and improved outcomes.
Area of Science:
- Pediatric Surgery
- Orthopedics
- Evidence-Based Medicine
Background:
- Pediatric spinal fusion surgery presents significant perioperative management challenges.
- Enhanced Recovery After Surgery (ERAS) is an evidence-based, multidisciplinary approach to optimize patient care.
- The application of ERAS protocols in pediatric spine surgery is not well-studied.
Purpose of the Study:
- To systematically review and analyze the existing literature on ERAS protocols in pediatric spinal surgery.
- To evaluate the impact of ERAS protocols on length of stay, pain, time-to-stand, and complication rates.
Main Methods:
- A systematic review and meta-analysis was performed adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
- Statistical analysis was conducted using Cochrane's RevMan (version 5.4).
Main Results:
- Seventeen studies involving 2733 pediatric patients were analyzed.
- ERAS protocol implementation led to significant reductions in length of stay (P < 0.001), time-to-stand (P < 0.001), total complications (P = 0.02), and estimated blood loss (P = 0.001).
Conclusions:
- ERAS protocols significantly improve outcomes for pediatric patients undergoing spinal surgery.
- ERAS has the potential to reduce healthcare costs, increase access to care, and establish a new standard.
- Further research is recommended to broaden ERAS applications across various spinal pathologies and assess long-term benefits.
Background:
Pediatric spinal fusion surgery is a complex procedure that poses challenges in perioperative management. The enhanced recovery after surgery (ERAS) approach is an evidence-based, multidisciplinary strategy to optimize patient care in an individualized, multidisciplinary way. Despite the benefits of ERAS protocol implementation, the role of ERAS in pediatric spine surgery remains understudied. This systematic review and meta-analysis aims to evaluate the current literature regarding pediatric spinal surgery ERAS protocols and their ability to decrease the length of stay, pain, time-to-stand, and complications.
Methods:
A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Statistical analyses were performed using Cochrane's RevMan (version 5.4).
Results:
Seventeen studies totaling 2733 patients were included in this analysis. Patients treated in an ERAS protocol had significant reductions in length of stay (P < 0.001), time-to-stand (P < 0.001), total complications (P = 0.02), and estimated blood loss (P = 0.001).
Conclusions:
ERAS protocol implementation can significantly enhance outcomes for pediatric patients receiving spinal surgery. Consequently, ERAS protocols have the potential to lower healthcare expenses, increase access, and set a new standard of care. Future research should be conducted to expand pediatric ERAS protocols to a diverse range of spinal pathologies and assess the long-term advantages of this practice.
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