Lele AV et al.
Journal of Neurosurgical Anesthesiology. 2025 Jul;37(3):242–254.
This systematic review and meta-analysis evaluates the global implementation of enhanced recovery after spine surgery (spine ERAS) across World Bank-defined high-income countries (HICs) and low- and middle-income countries (LMICs). Analyzing 83 studies for length of stay (LOS) and 20 for cost, the authors found that ERAS protocols significantly reduced LOS in both LMICs (−2.06 days) and HICs (−0.99 days), with consistent effects across surgical levels and procedure types.
Preoperative optimization was more commonly implemented in LMICs, and LMIC studies were more likely to be randomized controlled trials. However, cost reductions were not statistically significant due to high heterogeneity and variability in reporting standards. Only 14 studies reported protocol compliance, and areas like early mobility and early catheter removal showed low adherence. Pediatric and elderly populations remain underrepresented in the literature.
Despite limitations, the findings support ERAS as an effective global strategy to reduce hospital stays in spine surgery. The study highlights the need for standardization, better compliance tracking, and cost-effectiveness evaluations in future research.
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