Perioperative Enhanced Recovery After Surgery (ERAS) Clinical Pathway for Unilateral Biportal Endoscopy with Unilateral Laminotomy for Bilateral Decompression

Abstract

Objective: Unilateral biportal endoscopy with unilateral laminotomy for bilateral decompression (UBE-ULBD) is a widely utilized minimally invasive surgical technique for treating lumbar spinal stenosis (LSS). This study aimed to evaluate the effectiveness of the enhanced recovery after surgery (ERAS) clinical pathway in improving perioperative and short-term clinical outcomes for patients undergoing UBE-ULBD for LSS.

Methods: A retrospective cohort study was conducted on the clinical data of patients who underwent UBE-ULBD surgery for LSS from May 2022 to April 2024. Since the implementation of the ERAS clinical pathway in our department in May 2023, all eligible patients were divided into the ERAS group (May 2023–April 2024) and the traditional group (May 2022–April 2023). The two groups were analyzed for Visual Analog Scale (VAS) scores for lower extremities at preoperative, 6, 24, and 48 h postoperatively and on the day of discharge. In addition, the Oswestry Disability Index (ODI) and walking distances were assessed preoperatively, at 3 months postoperatively, and at 6 months postoperatively. Other parameters evaluated included the time to first ambulation after surgery, total length of hospital stay (LOS), postoperative LOS, perioperative opioid consumption, postoperative rehydration volume, and the incidence of postoperative complications.

Result: Compared to the traditional group, patients in the ERAS group demonstrated significantly lower pain scores at 6 and 24 h postoperatively, earlier ambulation, shorter total LOS and postoperative LOS, reduced postoperative rehydration volume, and perioperative opioid application (p < 0.05). No statistically significant differences were observed between the two groups in terms of lower extremities VAS scores before surgery, at 48 h postoperatively, and on the day of discharge. No statistically significant differences were observed in ODI scores before surgery, at 3 months postoperatively, and at 6 months postoperatively, as well as walking distances (p > 0.05). Furthermore, the incidence of complications was comparable between the two groups (p > 0.05).

Conclusion: The UBE-ULBD surgery under the guidance of the ERAS program, through multidisciplinary collaboration and comprehensive measures, can significantly optimize perioperative management, improve postoperative recovery quality, and achieve satisfactory perioperative and short-term clinical outcomes.

Keywords

enhanced recovery after surgery (ERAS) / length of hospital stay (LOS) / lumbar spinal stenosis (LSS) / postoperative ambulation time / unilateral biportal endoscopy (UBE) / unilateral laminotomy for bilateral decompression (ULBD)

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2025 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.