Enhanced Recovery after Surgery (ERAS) Reduces Hospital Stay and Postoperative Nausea in ACDF: A Meta-Analysis of...

Study DesignRetrospective Study.ObjectiveEnhanced Recovery After Surgery (ERAS) is gaining traction in spine surgery, yet high-level evidence specifically for Anterior Cervical Discectomy and Fusion (ACDF) remains sparse. This meta-analysis systematically evaluates the clinical efficacy and safety of ERAS protocols in patients undergoing ACDF.MethodsFollowing PRISMA 2020 and AMSTAR-2 guidelines, we searched Embase, PubMed, Cochrane Library, and Web of Science databases from their inception to December 2025. The Newcastle-Ottawa Scale (NOS) was employed to appraise quality. Pooled estimates of mean differences (MDs) or odds ratios (ORs) were derived using a random-effects model. Sensitivity and subgroup analyses were additionally executed. Primary outcomes encompassed postoperative complications and length of stay (LOS) following ACDF with ERAS. The certainty of evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Statistical analysis was performed using Review Manager 5.4.ResultsFive studies involving 2330 patients (ERAS: 1108; conventional: 1222) were included. All studies demonstrated high methodological quality (NOS 7-9). Implementation of ERAS was associated with a significant reduction in length of stay (MD=-1.56; 95% CI: -1.83 to -1.28; P<0.001; Moderate-certainty evidence) and a markedly lower incidence of postoperative nausea and vomiting(OR: 0.32; 95% CI: 0.15 to 0.68; P=0.03;High-certainty evidence). No significant differences were observed in overall complications(OR: 0.78; 95% CI: 0.37 to 1.63; Low-certainty evidence), hardware failure, surgical site infections, or dysphagia/dysphonia (all P> 0.05). Patient satisfaction showed a non-significant positive trend(OR: 1.31; 95% CI: 0.99 to 1.73; Low-certainty evidence).ConclusionBased on moderate-to-high certainty evidence, ERAS protocols significantly optimize perioperative recovery for ACDF by reducing hospital stay and gastrointestinal morbidity without compromising safety or patient satisfaction. These findings support the standardization and broader implementation of ERAS pathways in cervical spine surgery.