Impact of Enhanced Recovery After Surgery Protocols on Outcomes Up to Two Years After Adult Structural Spine Disorder Surgery.

IF 2.6 2区 医学 Q2 CLINICAL NEUROLOGY
Spine Pub Date : 2025-03-15 Epub Date: 2024-11-13 DOI:10.1097/BRS.0000000000005213
Anthony Yung, Oluwatobi O Onafowokan, Ankita Das, Max R Fisher, Ethan J Cottrill, Isabel P Prado, Iryna Ivasyk, Caroline M Wu, Peter S Tretiakov, Elizbeth L Lord, Pawel P Jankowski, Douglas G Orndorff, Andrew J Schoenfeld, Christopher I Shaffrey, Peter G Passias
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引用次数: 0

Abstract

Study design: Retrospective cohort study of prospectively enrolled database.

Objective: We analyze the recovery pattern of patients with adult structural spine disorder (ASD) who underwent corrective surgery with enhanced recovery after surgery (ERAS+) protocol, including physical and psychological prehabilitation components, compared with a non-ERAS protocol (ERAS-) up to 2 years (2Y) after surgery.

Background: Spine surgery for ASD is often highly invasive, which can contribute to prolonged recovery. The trajectory of recovery may be accelerated by the application of enhanced recovery principles.

Materials and methods: Inclusion criteria were operative patients with ASD older than 18 years with complete baseline, 90 days perioperative, and 2Y postoperative data. We assessed differences in baseline demographics, surgical details, baseline health-related quality of life (HRQL), and surgical outcomes between ERAS+ and ERAS- patients. Outcomes included adverse events, reoperations, and radiographic parameters such as sacral slope, pelvic tilt, pelvic incidence-lumbar lordosis mismatch, sagittal vertical axis, lumbar lordosis, T2 to T12 kyphosis, and maximum Cobb angle. In addition, HRQL measures included the physical component summary, Oswestry Disability Index, Neck Disability Index, EuroQol 5 dimensions, Scoliosis Research Society Questionnaire 22r total and domain scores, Numeric Pain Rating Scale-back, and Numeric Pain Rating Scale-leg. We used multivariable logistic regression and analysis of covariance to adjust for confounding.

Results: A total of 471 patients with ASD met the inclusion criteria, with 59 designated ERAS+. Those individuals with ERAS+ were older (64.1 ± 13.0 vs. 58.0 ± 16.0; P = 0.005), had a higher Charlson Comorbidity Index, (2.4 ± 1.8 vs. 1.4 ± 1.6; P < 0.001), and exhibited a higher modified ASD frailty index (8.2 ± 5.4 vs. 6.3 ± 4.9; P = 0.019). The adjusted analysis demonstrated the ERAS+ cohort demonstrated a lower likelihood of overall reoperations (Odds ratio (OR): 0.3; 95% CI: 0.13-0.89), and a lower likelihood of overall adverse events (OR: 0.4; 95% CI: 0.19-0.93). ERAS+ was more likely to achieve the minimal clinically important difference in the Scoliosis Research Society Questionnaire 22r total scores at 6 months (6M; OR: 3.1; 95% CI: 1.2-8.4), self-image domain at 6M (OR: 9.0; 95% CI: 1.6-50.0), in the pain domain at 6M (OR: 3.5; 95% CI: 1.01-11.9) and 1 year postoperatively (OR: 2.6; 95% CI: 1.03-6.7), and in the SF-36's physical component summary (PCS) scores at 1 year (OR: 2.1; 95% CI: 1.05-4.2). No other statistically significant differences in HRQL were observed at the remaining time points (P > 0.05).

Conclusion: Our work is the first to evaluate HRQL metrics and complications over 2Y following ASD correction with ERAS. Despite presenting with more severe baseline frailty and higher comorbidity profiles, patients with ASD who underwent corrective surgery with an ERAS protocol experienced fewer short-term adverse events and improved HRQL. We believe ERAS following ASD surgery leads to faster functional recovery, reduced postoperative deconditioning, and improved quality of life.

手术后增强恢复方案对成人结构性脊柱疾病手术后两年预后的影响。
研究设计:前瞻性纳入数据库的回顾性队列研究。目的:我们分析成人结构性脊柱障碍(ASD)患者接受矫正手术后增强恢复(ERAS+)方案的恢复模式,包括术后2年(2Y)的生理和心理康复成分,与非ERAS方案(ERAS-)相比。背景:ASD的脊柱手术通常是高度侵入性的,这有助于延长恢复时间。加强采油原则的应用可以加速采油的轨迹。材料和方法:入选标准为年龄大于18岁、基线完整、围手术期90天、术后2年的ASD手术患者。我们评估了ERAS+和ERAS-患者在基线人口统计学、手术细节、基线健康相关生活质量(HRQL)和手术结果方面的差异。结果包括不良事件、再手术和影像学参数,如骶骨斜度、骨盆倾斜、骨盆发生率-腰椎前凸不匹配、矢状垂直轴、腰椎前凸、T2至T12后凸和最大Cobb角。此外,HRQL测量包括身体成分总结、Oswestry残疾指数、颈部残疾指数、EuroQol 5维度、脊柱侧凸研究学会问卷22r总分和领域得分、数字疼痛评定量表和数字疼痛评定量表-腿。我们使用多变量逻辑回归和协方差分析来调整混杂。结果:471例ASD患者符合纳入标准,59例ERAS+。ERAS+的患者年龄较大(64.1±13.0∶58.0±16.0;P = 0.005), Charlson合并症指数较高,分别为(2.4±1.8∶1.4±1.6;P < 0.001),并且表现出更高的改良ASD脆弱指数(8.2±5.4比6.3±4.9;P = 0.019)。调整后的分析显示ERAS+组总体再手术的可能性较低(优势比(OR): 0.3;95% CI: 0.13-0.89),总体不良事件的可能性较低(OR: 0.4;95% ci: 0.19-0.93)。ERAS+更有可能在6个月时脊柱侧凸研究协会问卷22r总分(6M;OR: 3.1;95% CI: 1.2-8.4),自我图像域在6M (OR: 9.0;95% CI: 1.6-50.0),疼痛域在6M时(OR: 3.5;95% CI: 1.01-11.9)和术后1年(OR: 2.6;95% CI: 1.03-6.7),以及SF-36 1年的物理成分总结(PCS)评分(OR: 2.1;95% ci: 1.05-4.2)。其余时间点HRQL差异无统计学意义(P < 0.05)。结论:我们的研究首次评估了采用ERAS矫正ASD后的HRQL指标和并发症。尽管表现出更严重的基线虚弱和更高的合并症,接受ERAS矫正手术的ASD患者经历了更少的短期不良事件和改善的HRQL。我们相信,ASD手术后的ERAS可以更快地恢复功能,减少术后障碍,提高生活质量。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Spine
Spine 医学-临床神经学
CiteScore
5.90
自引率
6.70%
发文量
361
审稿时长
6.0 months
期刊介绍: Lippincott Williams & Wilkins is a leading international publisher of professional health information for physicians, nurses, specialized clinicians and students. For a complete listing of titles currently published by Lippincott Williams & Wilkins and detailed information about print, online, and other offerings, please visit the LWW Online Store. Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.
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