ERAS-guided matrix nursing pathway targeting risk factors in spine surgery: development and prospective evaluation

To identify independent risk factors for postoperative infectious complications after spinal surgery and to develop and prospectively evaluate an enhanced recovery after surgery (ERAS)-guided, matrix-structured nursing pathway targeting these risks.

This mixed-methods study included a retrospective analysis of 220 patients who underwent elective spinal surgery between January 2022 and December 2024. Univariate and multivariable logistic regression analyses were performed to identify independent factors associated with postoperative infectious complications, and predictive performance was assessed using receiver operating characteristic (ROC) analysis. Based on ERAS principles and the identified risk factors, a matrix-structured nursing intervention pathway was developed through multidisciplinary expert consensus. The pathway was then implemented in a prospective cohort of 50 patients (January-June 2025) and compared with 50 matched controls receiving conventional care from the retrospective cohort.

Advanced age, longer operative duration, and greater intraoperative blood loss were independent risk factors, whereas prophylactic antibiotic use was protective (all p < 0.05). The combined model demonstrated excellent discrimination (AUC = 0.940). Compared with controls, the intervention group had a lower postoperative complication rate (8% vs. 24%, p = 0.029) and shorter operative duration and postoperative hospital stay, with reduced intraoperative blood loss (all p < 0.05).

Advanced age, prolonged operative duration, and increased intraoperative blood loss were independently associated with postoperative infectious complications, while prophylactic antibiotic use was protective. The ERAS-guided, matrix-structured nursing pathway was feasible and was associated with improved perioperative outcomes, supporting its potential value for optimizing perioperative care in spinal surgery.