Accelerating Remobilization Time Following Spine Surgery Using Enhanced Recovery After Surgery: A Randomized Controlled Trial

Abstract

Background: The enhanced recovery after surgery (ERAS) protocol encompasses a set of evidence-based interventions implemented preoperatively, intraoperatively, and postoperatively. Objectives: This study aimed to assess the impact of applying an accelerated recovery method on remobilization time in patients undergoing spinal surgery compared to a control group. Methods: This randomized controlled trial took place at Shariati Hospital in Tehran, Iran. Eligible participants scheduled for elective spine surgery were enrolled in the study. Remobilization was defined as the patient's ability to independently leave the bed and ambulate. The ERAS protocol, derived from recommendations by the ERAS Society, was implemented. Total intravenous anesthesia was administered for induction and maintenance. The means of variables between the control and intervention groups were compared using an independent t-test. Changes in patients' pain intensity over time were examined through a repeated-measures ANOVA test. Multiple regression analysis was conducted to identify predictors of remobilization time. Results: A total of 70 patients (mean age 47.56 ± 14.08) were included in the study. The control group exhibited a significantly longer hospital stay compared to the ERAS group (46 h vs. 32 h). Furthermore, the ERAS group demonstrated a significantly shorter remobilization time after surgery compared to the control group (18 h vs. 8 h) (P < 0.001). Both groups exhibited a downward trend in overall pain, with the ERAS group experiencing a significantly faster pain reduction (η2 = 0.106, λ = 0.171, P < 0.001). Remobilization time exhibited significant correlations with pain intensity immediately after surgery (r = 0.651, P < 0.001), pain intensity one hour after surgery (r = 0.723, P < 0.001), pain intensity six hours after surgery (r = 0.391, P = 0.001), fentanyl dose (r = 0.728, P < 0.001), and length of hospital stay (r = 0.727, P < 0.001). Multiple regression analysis revealed that pain intensity one hour after surgery, fentanyl dose, and hospital stay significantly predicted remobilization time (F (9,60) = 22.751, P < 0.001). Conclusions: The implementation of the ERAS protocol yielded several beneficial outcomes, including reduced pain intensity, shorter ICU and hospital stays, and accelerated remobilization time. Pain intensity and opioid consumption (as analgesia) emerged as significant predictors of remobilization time.