Degenerative disorders of the lumbar spine decrease the mobility and quality of life of elderly patients. Lumbar fusion surgery is the primary method of treating degenerative lumbar spine disorders; however, the surgical stress response associated with major surgery has been linked to pathophysiological changes in the elderly, resulting in undesirable postoperative morbidity, complications, pain, fatigue, and extended convalescence. In the present study, we aimed to determine whether enhanced recovery after surgery significantly improved satisfaction and outcomes in elderly patients (> 65 years old) with short-level lumbar fusion. The study enrolled lumbar disc herniation or lumbar spinal stenosis patients if they were over the age of 65 years old underwent lumbar fusion at one or two levels. Data including demographic, comorbidity, and surgical information were collected from electronic medical records. Enhanced recovery after surgery interventions was categorized as preoperative, intraoperative, and postoperative. We also evaluated primary outcome, surgical complication, length of stay, postoperative pain scores, and 30-day readmission rates. A total of 192 patients were included, 96 in the enhanced recovery after surgery group and 96 case-matched patients in the non- enhanced recovery after surgery group. There were no statistically significant intergroup differences in regards to demographics, comorbidities, American Society of Anaesthesiologists grade, or the number of fusion levels. There were also no differences between mean surgery time of intraoperative blood loss between the enhanced recovery after surgery and non- enhanced recovery after surgery groups. In addition, the mean preoperative Japanese Orthopaedic Association score, visual analog score for the back and legs, and Oswestry Disability Index score were not significantly different between the two groups. Overall, enhanced recovery after surgery pathway compliance was 92.1%. There were no significant differences in the number of complications or the mortality rates between the enhanced recovery after surgery and non-enhanced recovery after surgery groups. Furthermore, the mean postoperative Japanese Orthopaedic Association score, Visual analog score for the back and legs, Oswestry Disability Index score, and readmission rates score revealed no significant differences between the groups at 30-day follow-up point. However, we observed a statistically significant decrease in length of stay in the enhanced recovery after surgery group (12.30 ± 3.03 of enhanced recovery after surgery group versus 15.50 ± 1.88 in non- enhanced recovery after surgery group, p = 0). Multivariable linear regression showed that comorbidities (p = 0.023) and implementation of enhanced recovery after surgery program (p = 0.002) were correlated with prolonged length of stay. Multivariable logistic regression showed that no characteristics were associated with complications. This report describes the first enhanced recovery after surgery protocol used in elderly patients after short-level lumbar fusion surgery. Our enhanced recovery after surgery program is safe and could help decrease length of stay in elderly patients with short-level lumbar fusion.

中文翻译：

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老年浅度腰椎融合患者的术后恢复（ERAS）程序增强。

腰椎退行性疾病降低了老年患者的活动能力和生活质量。腰椎融合手术是治疗退行性腰椎疾病的主要方法。然而，与大手术相关的手术压力反应与老年人的病理生理变化有关，导致不良的术后发病率，并发症，疼痛，疲劳和延长的疗养期。在本研究中，我们旨在确定术后短时间腰椎融合的老年患者（> 65岁）术后恢复增强是否能显着提高满意度和预后。这项研究招募了65岁以上的腰椎间盘突出症或腰椎管狭窄症患者，接受一或两个水平的腰椎融合术。数据包括人口统计，合并症，并从电子病历中收集手术信息。手术干预后恢复的恢复可分为术前，术中和术后。我们还评估了主要结局，手术并发症，住院时间，术后疼痛评分和30天再入院率。总共192例患者被纳入研究，手术后增强恢复组96例，手术后非增强恢复组96例匹配的患者。在人口统计学，合并症，美国麻醉医师学会评分或融合水平数量方面，在组间没有统计学上的显着差异。两组术后平均恢复时间之间无差异。此外，两组之间的平均术前日本骨科协会评分，背部和腿部视觉模拟评分以及Oswestry残疾指数评分均无显着差异。总体而言，手术路径顺应性后的恢复增强率为92.1％。手术后恢复增强组和手术后非增强恢复组在并发症数量或死亡率上无显着差异。此外，日本骨科协会术后平均评分，后腿和腿部视觉模拟评分，Oswestry残疾指数评分和再入院率评分显示，在30天随访时两组之间无显着差异。但是，我们观察到手术后恢复增强组的住院时间在统计学上显着减少（12。手术组恢复后的恢复为30±3.03，而手术后未恢复组的恢复为15.50±1.88，p = 0）。多变量线性回归显示，合并症（p = 0.023）和手术程序实施后恢复增强（p = 0.002）与住院时间延长相关。多变量logistic回归显示没有特征与并发症相关。该报告描述了老年患者短期腰椎融合手术后首次手术后恢复增强。我们提高的术后程序恢复率是安全的，并且可以帮助缩短患有短期腰椎融合的老年患者的住院时间。多变量线性回归显示，合并症（p = 0.023）和手术程序实施后恢复增强（p = 0.002）与住院时间延长相关。多变量logistic回归显示没有特征与并发症相关。该报告描述了老年患者短期腰椎融合手术后首次手术后恢复增强。我们提高的术后程序恢复率是安全的，并且可以帮助缩短患有短期腰椎融合的老年患者的住院时间。多变量线性回归显示，合并症（p = 0.023）和手术程序实施后恢复增强（p = 0.002）与住院时间延长相关。多变量logistic回归显示没有特征与并发症相关。该报告描述了老年患者短期腰椎融合手术后首次手术后恢复增强。我们提高的术后程序恢复率是安全的，并且可以帮助缩短患有短期腰椎融合的老年患者的住院时间。该报告描述了老年患者短期腰椎融合手术后首次手术后恢复增强。我们提高的术后程序恢复率是安全的，并且可以帮助缩短患有短期腰椎融合的老年患者的住院时间。该报告描述了老年患者短期腰椎融合手术后首次手术后恢复增强。我们提高的术后程序恢复是安全的，并且可以帮助缩短患有短期腰椎融合的老年患者的住院时间。