Enhanced recovery after surgery for microsurgical oblique lateral interbody fusion

This study evaluates the real-world effectiveness and safety of a standardized enhanced recovery after surgery (ERAS) pathway in patients undergoing single-level microsurgical oblique lateral interbody fusion (MIS-OLIF) for lumbar degenerative disease. This retrospective before-and-after cohort study included 89 patients who underwent single-level MIS-OLIF at L3-4 or L4-5 between January 2021 and December 2023. Patients were categorized according to the institutional perioperative pathway in effect at the time of surgery: conventional care (n = 44) or ERAS (n = 45). The primary outcome was postoperative length of stay. Secondary outcomes included back-pain and leg-pain visual analog scale (VAS) scores, Oswestry Disability Index (ODI), ERAS-component adherence, discharge readiness, complications, readmission, and patient satisfaction. Selection bias was addressed using propensity-score overlap weighting, and repeated VAS and ODI measurements were analyzed using linear mixed-effects models. The ERAS group had a shorter unadjusted hospital stay than the conventional-care group (6.2 ± 0.8 vs 7.5 ± 1.2 days). After overlap-weighting adjustment, ERAS was associated with an adjusted reduction in postoperative length of stay of −1.1 days (95% confidence interval [CI]: −1.4 to −0.8; P < .001). Early postoperative back and leg pain were significantly lower in the ERAS group (group-by-time interaction P = .02 and P = .04, respectively). Overall ERAS adherence was 94.7% (median). Complication rates were 11.1% vs 18.2% (adjusted odds ratio 0.52, 95% CI: 0.14–1.94, P = .33), and satisfaction rates (satisfied/very satisfied) were 97.8% vs 93.2% ( P = .36). In this single-center real-world cohort, implementation of a standardized ERAS pathway was associated with earlier discharge after single-level MIS-OLIF. The effects on pain, function, satisfaction, and safety should be interpreted according to the adjusted analyses and remain subject to residual confounding inherent in the retrospective before-and-after design.