Enhanced Recovery After Surgery (ERAS) Program for Anterior Cervical Discectomy and Fusion (ACDF) in Patients Over 60 Years Old

Peng Wang,1– 3,* Chao Kong,1– 3,* Ze Teng,4 Sitao Zhang,1– 3 Peng Cui,1– 3 Shuaikang Wang,1– 3 Guoguang Zhao,2,3 Shibao Lu1– 3 1Department of Orthopedics, Xuanwu Hospital of Capital Medical University, Beijing, 100053, People’s Republic of China; 2National Clinical Research Center for Geriatric Diseases, Beijing, 100053, People’s Republic of China; 3Beijing Municipal Geriatric Medical Research Center, Beijing, 100053, People’s Republic of China; 4Department of Radiology, Cancer Hospital Chinese Academy of Medical Sciences, Beijing, 100021, People’s Republic of China*These authors contributed equally to this workCorrespondence: Shibao Lu, Department of Orthopedics, Xuanwu Hospital of Capital Medical University, 45 Changchun Street, Xicheng, Beijing, 100053, People’s Republic of China, Email shibaoluspine@sina.com Guoguang Zhao, National Clinical Research Center for Geriatric Diseases, 45 Changchun Street, Xicheng, Beijing, 100053, People’s Republic of China, Email cmuzhaogg@163.comBackground: Enhanced recovery after surgery (ERAS) is currently widely used in many surgical specialties, but there is still a lack of concern about the cervical ERAS program for old patients (> 60 years old). We aimed to determine whether our ERAS program significantly improved satisfaction and outcomes in old patients (> 60 years old) with anterior cervical discectomy and fusion (ACDF).Methods: This is a retrospective cohort study. The study enrolled patients if they were over the age of 60 years old underwent ACDF from July 2019 and June 2021 (ERAS group) and from January 2018 and June 2019 (non-ERAS group). Data including demographic, comorbidity, and surgical information were collected. We also evaluated ERAS process compliance, primary outcome, surgical complication, and length of stay (LOS).Results: There were 135 patients in the ERAS group, and 122 patients in the non-ERAS group were included. A comparison of the demographic data revealed that there were no statistically significant intergroup differences observed between the group. Overall, ERAS pathway compliance was 91.9%. There were no significant differences in the fusion levels, operative time, intraoperative blood loss, postoperative VAS score, and complications between the ERAS and non-ERAS groups. In addition, there was no significant difference in readmission and mortality at 30-day follow-up between the two groups. However, we observed a statistically significant decrease in the LOS in the ERAS group (8.68± 2.34 of ERAS group versus 10.43± 4.05 in non-ERAS group, p=0.013).Conclusion: This report describes the first ERAS protocol used in old patients with ACDF. Our ERAS program is safe and associated with incremental benefits with respect to LOS in old patients with ACDF.Keywords: enhanced recovery after surgery, old, anterior cervical discectomy and fusion