Enhanced recovery after spinal surgery protocol versus conventional care in non- insulin diabetic patients: A prospective randomized trial

Abstract

Background: Enhanced Recovery After Surgery (ERAS) approach was proven in many surgical specialties. This prospective, randomized, single-blinded trial was designed to assess the effectiveness of ERAS on quality of recovery (QOR) after surgery in non-insulin-dependent diabetic patients. Patients and methods: 72 patients undergoing elective lumbar decompressive surgery were randomly allocated to one of two equal groups receiving either ERAS protocol in group E or conventional care in group C. QOR after surgery using QOR-40 score, pain score, perioperative opioid consumption, time to early ambulation, serum markers of stress response, length of stay and possible perioperative complications were recorded. Results: QOR-40 scores were significantly greater in group E at PACU, first postoperative day and second postoperative day (P = 0.015, 0.041 and 0.048, respectively). VAS was significantly lower in group E in the first eight hours postoperative. Time to first postoperative analgesic requirement was significantly longer in group E (P = 0.0001). Intraoperative fentanyl and postoperative nalbuphine requirements were significantly less in group E (P = 0.001, and 0.0001, respectively). Time to early ambulation was significantly less in group E (P = 0.006). Both CRP and interleukin-6 were significantly less at the second postoperative day in group E (P = 0.001, and 0.017, respectively). There was insignificant difference among groups in length of hospital stay and intraoperative insulin requirements (P = 0.251, and 0.347, respectively). Conclusion: In non-insulin diabetic patients, enhanced recovery after spinal surgery improved quality of recovery, lowered pain scores, reduced perioperative opioid consumption, allowed early ambulation and decreased stress response but not length of hospital stay.