BACKGROUND The best evidence-enhanced recovery care pathway is yet to be defined for patients undergoing spinal surgery. Minimally invasive surgery, multimodal analgesia, early mobilization, and early postoperative nutrition have been considered as critical components of enhanced recovery in spinal surgery (ERSS). The objective of this study will be to synthesize the evidence underpinning individual components of a proposed multidisciplinary enhanced recovery pathway for patients undergoing spinal surgery. METHODS This is the study protocol for a systematic review of complex interventions. Our team identified 22 individual care components of a proposed pathway based on clinical practice guidelines and published reviews. We will include systematic reviews and meta-analysis, randomized controlled trials, non-randomized controlled trials, and observational studies in adults or pediatric patients evaluating any one of the pre-determined care components. Our primary outcomes will be all-cause mortality, morbidity outcomes (e.g., pulmonary, cardiac, renal, surgical complications), patient-reported outcomes and experiences (e.g., pain, quality of care experience), and health services outcomes (e.g., length of stay and costs). We will search the following databases (1990 onwards) MEDLINE, EMBASE, and Cochrane Library (Cochrane Database of Systematic Reviews and CENTRAL). Two reviewers will independently screen all citations, full-text articles, and abstract data. Potential conflicts will be resolved through discussion. The risk of bias for individual studies will be appraised using appropriate tools. A narrative synthesis will be provided with the information presented in the text and tables to summarize and explain the characteristics and findings of the included studies. Due to clinical and methodological heterogeneity, we do not anticipate to conduct meta-analyses. Confidence in cumulative evidence for each component of care will be classified according to the GRADE system. DISCUSSION This systematic review will identify, evaluate, and integrate the evidence underpinning individual components of a pathway for patients undergoing spinal surgery. The formation of an evidence-based pathway will allow for the standardization of clinical care delivery within the context of enhanced recovery in spinal surgery. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019135289.

中文翻译：

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脊柱手术后接受加速康复治疗的患者的拟议途径：系统评价方案。

背景 对于接受脊柱手术的患者来说，最佳的循证康复护理途径尚未确定。微创手术、多模式镇痛、早期活动和术后早期营养被认为是脊柱外科加速康复外科（ERSS）的关键组成部分。本研究的目的是综合支持脊柱手术患者多学科加速康复路径各个组成部分的证据。方法 这是对复杂干预措施进行系统评价的研究方案。我们的团队根据临床实践指南和已发表的评论，确定了拟议路径的 22 个个人护理组成部分。我们将包括系统评价和荟萃分析、随机对照试验、非随机对照试验以及针对成人或儿童患者的观察性研究，评估任何一项预先确定的护理组成部分。我们的主要结局将是全因死亡率、发病结局（例如肺、心、肾、手术并发症）、患者报告的结局和经历（例如疼痛、护理体验质量）以及卫生服务结局（例如持续时间）住宿和费用）。我们将检索以下数据库（1990 年起）MEDLINE、EMBASE 和 Cochrane Library（Cochrane Database of Systematic Reviews 和 CENTRAL）。两名审稿人将独立筛选所有引文、全文文章和摘要数据。潜在的冲突将通过讨论解决。将使用适当的工具评估个别研究的偏倚风险。将提供文本和表格中提供的信息的叙述性综合，以总结和解释所纳入研究的特征和结果。由于临床和方法学异质性，我们预计不会进行荟萃分析。每个护理组成部分的累积证据的置信度将根据 GRADE 系统进行分类。讨论 本系统综述将识别、评估和整合支持脊柱手术患者路径各个组成部分的证据。循证途径的形成将有助于在脊柱手术加速康复的背景下实现临床护理服务的标准化。系统审查注册 PROSPERO CRD42019135289。