Gastrointestinal Management Enhanced Recovery after Surgery Protocol Improves Postoperative Recovery in Patients Undergoing Posterior Lumbar Interbody Fusion.

Abstract

Study designRetrospective Study.ObjectivesPostoperative gastrointestinal dysfunction (POGD) adversely affects patient outcomes. ERAS protocols can improve postoperative outcomes by optimizing gastrointestinal (GI) function. This study aims to evaluate the effectiveness of a GI management ERAS protocol in patients with posterior lumbar interbody fusion (PLIF) surgery.MethodsA retrospective analysis was conducted on patients who underwent PLIF between 2017 and 2020 in a single institution. The control group included patients treated before the institution adopted updated ERAS protocols including GI management, and the intervention group included patients treated after, with special intestinal preparation, intake and GI management. Demographic data, intraoperative and postoperative variables, and GI assessments were analyzed.ResultsThe study included 163 patients: 78 in the intervention group and 85 in the control group. No significant differences were found in demographics, perioperative variables, comorbidities, or postoperative VAS and ODI scores. In the intervention group, the postoperative length of stay and ambulation time were reduced by 45.0% (<i>P</i> = 0.02) and 68.0% (<i>P</i> = 0.01), respectively. They also had lower rates of postoperative complications, including poor feeding (11.6%, <i>P</i> = 0.02), nausea and vomiting (11.6%, <i>P</i> = 0.03), hypoalbuminemia (10.3%, <i>P</i> = 0.04), and constipation (24.4%, <i>P</i> < 0.01). The time to first postoperative flatus and defecation was reduced by 41.5% (<i>P</i> < 0.01) and 30.1% (<i>P</i> = 0.02). PAC-SYM was decreased by 31.9% (<i>P</i> < 0.01), and GIS was decreased by 41.2% (<i>P</i> < 0.01).ConclusionsImplementing a GI management ERAS protocol accelerates postoperative recovery in PLIF surgery. Integrating these strategies into standard perioperative care may not only diminish the incidence of postoperative GI dysfunction but also reduce complications, enhancing surgical outcomes.