Riassunto dello studio

Fifty-six patients undergoing a one or two-level lumbar spinal fusion procedure were randomized to undergo an enhanced recovery pathway (including 17 pre-, intra-, and post-operative care elements) or standard recovery pathway. The primary outcome of interest was the quality of recovery at 3 days post-operation which was measured using the quality of recovery 40 (QoR40) score. Secondary outcomes of interest included QoR40 scores over time, time to discharge from physical therapy, pain scores after physical therapy, duration of patient controlled analgesia, total opioid consumption, time to first oral intake, length of stay, incidence of complications, as well as levels of interleukin 6 (IL-6), C-reactive protein (CRP), and cortisol. QoR40 scores were significantly in favour of the enhanced recovery group at 3 days post-operation; no statistical significant differences in QoR40 scores were observed between the 2 groups at 0, 1, 2, 14, or 56 days post-operation. The median time to oral intake was significantly shorter in the enhanced recovery group (p=0.010). Length of stay (p=0.112), time to physical therapy discharge (p=0.116), and the incidences of all recorded complications (p>0.2 for all) were not significantly different between the two treatment arms. With the exception of CRP levels at post-operative day 3, which were significantly lower in the enhanced recovery group, no statistical significant differences in IL-6, cortisol, or CRP levels were observed between the two groups. The median duration of patient controlled analgesia was statistically significantly shorter in the enhanced recovery group. Opioid consumption in the first 24 hours, and pain scores after physical therapy on post-operative day 1, were statistically significantly lower in the enhanced recovery group.