Evaluation of the Enhanced Recovery After Surgery ( <scp>ERAS</scp> ) Guidance for Patients With Spinal Metastasis

Surgery continues to remain the most effective treatment for spinal metastasis (SM). As the number of surgeries continues to grow, the need for consensus guidelines for optimal perioperative care is imperative. Enhanced recovery after surgery (ERAS) protocols were created for this purpose. The objective of this study is to review evidence-based ERAS guidelines for SM surgery. A group of multiple experienced spine surgeons was invited to participate in this study. This group identified 19 ERAS items for SM surgery. The principal literature search utilized MEDLINE, Embase, and Cochrane databases to identify contributions related to the topic published. Systematic reviews, randomized controlled trials (RCTs), and observational cohort studies which reported SM surgery related to the ERAS topics were included. The evidence was graded according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Consensus recommendations were reached by the group after a critical appraisal of the literature. Five articles were included to develop the consensus statements for 19 ERAS items. All recommendations on ERAS protocol items are based on the best available evidence. They span topics from preoperative patient education and nutritional evaluation, intraoperative anesthetic and surgical techniques, and postoperative multimodal analgesic strategies. The level of evidence for the use of each recommendation is presented. Based on the best evidence available for each ERAS item within the multidisciplinary perioperative pathways, we presented this comprehensive consensus review for SM surgery. This ERAS elements can be implemented and practiced clinically.