Enhanced recovery after lumbar fusion surgery: an international survey on current practice.

Abstract

Study Design Cross-sectional, web-based international survey study. Objectives To assess spine surgeons’ perspectives on the importance of Enhanced Recovery After Surgery (ERAS) components and barriers to implementing ERAS programs in degenerative lumbar fusion. Methods In May 2024, a web-based survey was distributed to AOSpine members. The survey covered eight ERAS components derived from the 2021 consensus statement for perioperative care in lumbar fusion. Respondents selected up to three components with the biggest perceived impact on recovery and up to three with the greatest room for improvement. Responses were summarized in a priority matrix. Demographics, perceived barriers, and implementation support needs were analyzed using descriptive statistics. Results The survey was accessed by 400 individuals, yielding 322 responses (80.5%) and a 76.7% completion rate. Respondents represented academic (50.6%), private (28.9%), and local/community hospitals (20.5%) worldwide. ERAS components perceived to have the biggest impact on recovery were multimodal opioid-sparing analgesia (73.3%), early mobilization (63.8%), and preoperative education & counselling (58.6%), which were also identified as having the greatest room for improvement (39.4%, 41.4%, and 62.6%, respectively). Key barriers were the absence of clear protocols and guidelines (56.2%), staff shortages (53.8%), and difficulties coordinating implementation and adherence (43.0%). Conclusion Multimodal opioid-sparing analgesia, early mobilization, and preoperative education & counselling were identified as ERAS components with the biggest perceived impact on patient recovery and the greatest room for improvement. Targeted efforts in these domains may represent an important opportunity to enhance perioperative care and support the implementation of ERAS programs in lumbar spinal fusion.