OBJECTIVE Elderly patients are a vulnerable patient population in elective spinal surgery. Older patients have more medical comorbidities and are also more sensitive to opiate medications. Despite this, spine and peripheral nerve surgery is still feasible in these patients, and an Enhanced Recovery After Surgery (ERAS) regimen can further enhance the safety profile. METHODS This is a before and after cohort study at a single institution on elderly patients who underwent elective spine and peripheral nerve surgery. Patients were prospectively enrolled in a novel ERAS protocol from April 2017 to December 2018. The control group was a historical cohort of patients who underwent surgery from September 2016 to December 2016. The primary outcome was self-reported opioid use at 1- and 3-months postoperatively. The secondary outcome was compliance with the ERAS protocol across several measures including patient-controlled (PCA) use, patient-reported pain scores, mobilization and ambulation status, and Foley catheter use. RESULTS Among 504 patients aged 65 and older compared to historic controls there was a significant reduction in the use of post-operative opioids at one month (36.2% vs. 71.7%, p < 0.001) and 3 months after surgery (33.0% vs. 80.0%, p < 0.001). 504 consecutive elderly patients were included in the ERAS protocol compared to a control group of 60. The two groups had similar surgical procedures and baseline demographics, with similar mean ages (ERAS 73.2 years vs. control 73.5 years, p = 0.67). The ERAS group showed improved mobilization and ambulation on POD 0 in compliance with our protocol compared to the control group (mobilization: 60.0% vs. 10.0%, p < 0.001; ambulation: 36.1% vs. 10.0%, p < 0.001), with no inpatient falls reported for either group. CONCLUSIONS ERAS facilitates reduction in opiate use at 1- and 3-month intervals postoperatively in patients greater than 65 years old undergoing elective spine and peripheral nerve surgery. Early mobilization and ambulation are safe and feasible in this population.

中文翻译：

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加速康复 (ERAS) 途径在接受脊柱和周围神经手术的老年患者中的功效

目的 老年患者是择期脊柱手术中的弱势患者群体。老年患者有更多的医疗合并症，对阿片类药物也更敏感。尽管如此，脊柱和周围神经手术在这些患者中仍然是可行的，加速康复外科 (ERAS) 方案可以进一步提高安全性。方法 这是一项在单一机构对接受选择性脊柱和周围神经手术的老年患者进行的前后队列研究。患者在 2017 年 4 月至 2018 年 12 月期间前瞻性地纳入了一项新的 ERAS 协议。对照组是一组在 2016 年 9 月至 2016 年 12 月期间接受手术的患者。主要结果是自我报告的第 1 和第 3 次阿片类药物使用情况术后几个月。次要结果是在多项措施中符合 ERAS 协议，包括患者自控 (PCA) 使用、患者报告的疼痛评分、活动和走动状态以及 Foley 导管使用。结果 在 504 名 65 岁及以上的患者中，与历史对照组相比，术后 1 个月（36.2% 与 71.7%，p < 0.001）和术后 3 个月（33.0% 与 33.0%）显着减少了术后阿片类药物的使用。 80.0%，p < 0.001)。504 名连续老年患者被纳入 ERAS 方案，而对照组为 60 名。两组的手术程序和基线人口统计数据相似，平均年龄相似（ERAS 73.2 岁与对照组 73.5 岁，p = 0.67）。与对照组相比，ERAS 组在 POD 0 时表现出更好的活动和行走能力（活动：60.0% 与 10.0%，p < 0.001；行走：36.1% 与 10.0%，p < 0.001），与两组均未报告住院跌倒。结论 ERAS 有助于减少 65 岁以上接受选择性脊柱和周围神经手术的患者术后每 1 个月和 3 个月的阿片类药物使用量。在该人群中早期活动和下地活动是安全可行的。