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

Abstract

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.

Keywords

consensus statement / enhanced recovery after surgery / GRADE / recommendations / spinal metastasis

References

[1] R. J. Rothrock, O. Barzilai, A. S. Reiner, et al., “Survival Trends After Surgery for Spinal Metastatic Tumors: 20-Year Cancer Center Experience,” Neurosurgery 88, no. 2 (2021): 402–412.

[2] R. den Van Brande, E. M. Cornips, M. Peeters, P. Ost, C. Billiet, and E. de Van Kelft, “Epidemiology of Spinal Metastases, Metastatic Epidural Spinal Cord Compression and Pathologic Vertebral Compression Fractures in Patients With Solid Tumors: A Systematic Review,” Journal of Bone Oncology 35 (2022): 100446.

[3] M. Kritikos, J. Vivanco-Suarez, N. Teferi, et al., “Survival and Neurological Outcomes Following Management of Intramedullary Spinal Metastasis Patients: A Case Series With Comprehensive Review of the Literature,” Neurosurgical Review 47, no. 1 (2024): 75.

[4] P. Z. Sullivan, T. Niu, J. F. Abinader, et al., “Evolution of Surgical Treatment of Metastatic Spine Tumors,” Journal of Neuro-Oncology 157, no. 2 (2022): 277–283.

[5] M. Yin, Z. Sun, X. Ding, et al., “Cross-Cultural Adaptation and Validation of Simplified Chinese Version of the Spine Oncology Study Group Outcomes Questionnaire (SOSGOQ) 2.0 With Its Assessment in Clinical Setting,” Spine Journal 22, no. 12 (2022): 2024–2032.

[6] L. Qiao, X. Ding, S. He, et al., “Measurement Properties of Health-Related Quality of Life Measures for People Living With Metastatic Disease of the Spine: A Systematic Review,” International Journal of Surgery 110, no. 1 (2024): 419–430.

[7] J. Zheng, X. Ding, J. Wu, et al., “Prognostic Factors and Outcomes of Surgical Intervention for Patients With Spinal Metastases Secondary to Lung Cancer: An Update Systematic Review and Meta Analysis,” European Spine Journal 32, no. 1 (2023): 228–243.

[8] V. G. Igoumenou, A. F. Mavrogenis, A. Angelini, et al., “Complications of Spine Surgery for Metastasis,” European Journal of Orthopaedic Surgery & Traumatology 30, no. 1 (2020): 37–56.

[9] S. Alomari, J. Theodore, A. K. Ahmed, et al., “Development and External Validation of the Spinal Tumor Surgery Risk Index,” Neurosurgery 93, no. 2 (2023): 462–472.

[10] R. F. Planchard, D. Lubelski, J. Ehersman, et al., “Surgical Stabilization for Patients With Mechanical Back Pain Secondary to Metastatic Spinal Disease Is Associated With Improved Objective Mobility Metrics: Preliminary Analysis in a Cohort of 26 Patients,” World Neurosurgery 153 (2021): e28–e35.

[11] C. S. Kassicieh, A. J. Kassicieh, K. Rumalla, et al., “Hospital-Acquired Infection Following Spinal Tumor Surgery: A Frailty-Driven Pre-Operative Risk Model,” Clinical Neurology and Neurosurgery 225 (2023): 107591.

[12] J. Zou, G. Luo, L. Zhou, et al., “Nomogram for Predicting Postoperative Pulmonary Complications in Spinal Tumor Patients,” BMC Anesthesiology 24, no. 1 (2024): 56.

[13] M. Mohme, K. C. Mende, T. Kratzig, et al., “Impact of Spinal Cord Compression From Intradural and Epidural Spinal Tumors on Perioperative Symptoms-Implications for Surgical Decision Making,” Neurosurgery Review 40, no. 3 (2017): 377–387.

[14] A. A. Elsamadicy, O. Adogwa, D. T. Lubkin, et al., “Thirty-Day Complication and Readmission Rates Associated With Resection of Metastatic Spinal Tumors: A Single Institutional Experience,” Journal of Spine Surgery 4, no. 2 (2018): 304–310.

[15] S. Xu, M. H. L. Liow, X. Eric Liu, et al., “Enhanced Recovery After Surgery (ERAS) Protocol Reduces Need for Patient Selection for Day Surgery Total Knee Arthroplasty,” Journal of Orthopaedics 49 (2024): 18–23.

[16] B. Pinho and A. Costa, “Impact of Enhanced Recovery After Surgery (ERAS) Guidelines Implementation in Cesarean Delivery: A Systematic Review and Meta-Analysis,” European Journal of Obstetrics & Gynecology and Reproductive Biology 292 (2024): 201–209.

[17] J. Wang, C. Chen, D. Li, et al., “Enhanced Recovery After Surgery (ERAS) in Sacral Tumour Surgery and Comprehensive Description of a Multidisciplinary Program: A Prospective Study in a Specialized Hospital in China,” International Orthopaedics 48, no. 2 (2024): 581–601.

[18] T. Nieminen, L. Tapiovaara, L. Back, et al., “Enhanced Recovery After Surgery (ERAS) Protocol Improves Patient Outcomes in Free Flap Surgery for Head and Neck Cancer,” European Archives of Oto-Rhino-Laryngology 281, no. 2 (2024): 907–914.

[19] C. E. Crouch, E. Stewart, and A. Hendrickse, “Enhanced Recovery After Surgery for Liver Transplantation: A Review of Recent Literature,” Current Opinion in Organ Transplantation 29, no. 1 (2024): 64–71.

[20] M. Brindle, G. Nelson, D. N. Lobo, O. Ljungqvist, and U. O. Gustafsson, “Recommendations From the ERAS(R) Society for Standards for the Development of Enhanced Recovery After Surgery Guidelines,” BJS Open 4, no. 1 (2020): 157–163.

[21] M. J. Page, J. E. McKenzie, P. M. Bossuyt, et al., “The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews,” International Journal of Surgery 88 (2021): 105906.

[22] M. J. Page, J. E. McKenzie, P. M. Bossuyt, et al., “The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews,” BMJ (Clinical Research ed.) 372 (2021): n71.

[23] V. B. Chakravarthy, I. Laufer, A. G. Amin, et al., “Patient Outcomes Following Implementation of an Enhanced Recovery After Surgery Pathway for Patients With Metastatic Spine Tumors,” Cancer 128, no. 23 (2022): 4109–4118.

[24] R. M. Grasu, J. P. Cata, A. Q. Dang, et al., “Implementation of an Enhanced Recovery After Spine Surgery Program at a Large Cancer Center: A Preliminary Analysis,” Journal of Neurosurgery. Spine 29, no. 5 (2018): 588–598.

[25] B. Liu, S. Liu, Y. Wang, et al., “Enhanced Recovery After Intraspinal Tumor Surgery: A Single-Institutional Randomized Controlled Study,” World Neurosurgery 136 (2020): e542–e552.

[26] M. Lei, W. Zheng, Y. Cao, et al., “Treatment of Patients With Metastatic Epidural Spinal Cord Compression Using an Enhanced Recovery After Surgery Program,” Frontiers in Cell and Developmental Biology 11 (2023): 1183913.

[27] B. Feng, Y. Zheng, F. Tian, X. Liu, M. Zhang, and Y. Zheng, “Application of Rapid Rehabilitation Nursing in the Nursing of Patients With Spinal Metastases,” Basic and Clinical Oncology 34, no. 4 (2021): 355–357.

[28] B. Debono, T. W. Wainwright, M. Y. Wang, et al., “Consensus Statement for Perioperative Care in Lumbar Spinal Fusion: Enhanced Recovery After Surgery (ERAS(R)) Society Recommendations,” Spine Journal 21, no. 5 (2021): 729–752.

[29] J. T. Dang, V. G. Szeto, A. Elnahas, et al., “Canadian Consensus Statement: Enhanced Recovery After Surgery in Bariatric Surgery,” Surgical Endoscopy 34, no. 3 (2020): 1366–1375.

[30] S. Vincent, T. Paskey, E. Critchlow, et al., “Prospective Randomized Study Examining Preoperative Opioid Counseling on Postoperative Opioid Consumption After Upper Extremity Surgery,” Hand (N Y) 17, no. 2 (2022): 200–205.

[31] M. Low, L. C. Burgess, and T. W. Wainwright, “A Critical Analysis of the Exercise Prescription and Return to Activity Advice That Is Provided in Patient Information Leaflets Following Lumbar Spine Surgery,” Medicina (Kaunas, Lithuania) 55, no. 7 (2019): 347.

[32] A. Luzzati, C. Pizzigallo, I. Sperduti, et al., “En Bloc Surgery in the Thoracic Spine: Indications, Results, and Complications in a Series of Eighty-Five Patients Affected by Primary and Secondary Malignant Bone Tumors,” World Neurosurgery 185 (2024): e376–e386.

[33] J. C. Sassani, P. J. Grosse, L. Kunkle, L. Baranski, and M. F. Ackenbom, “Patient Preparedness for Pelvic Organ Prolapse Surgery: A Randomized Equivalence Trial of Preoperative Counseling,” Female Pelvic Medicine & Reconstructive Surgery 27, no. 12 (2021): 719–725.

[34] L. C. Burgess, J. Arundel, and T. W. Wainwright, “The Effect of Preoperative Education on Psychological, Clinical and Economic Outcomes in Elective Spinal Surgery: A Systematic Review,” Healthcare (Basel) 7, no. 1 (2019): 48.

[35] D. E. Spratt, W. H. Beeler, F. Y. de Moraes, et al., “An Integrated Multidisciplinary Algorithm for the Management of Spinal Metastases: An International Spine Oncology Consortium Report,” Lancet Oncology 18, no. 12 (2017): e720–e730.

[36] Y. Cui, M. Lei, Y. Pan, Y. Lin, and X. Shi, “Scoring Algorithms for Predicting Survival Prognosis in Patients With Metastatic Spinal Disease: The Current Status and Future Directions,” Clinical Spine Surgery 33, no. 8 (2020): 296–306.

[37] R. H. Aspera-Werz, J. Muck, C. Linnemann, et al., “Nicotine and Cotinine Induce Neutrophil Extracellular Trap Formation-Potential Risk for Impaired Wound Healing in Smokers,” Antioxidants 11, no. 12 (2022): 2424.

[38] R. S. Matulewicz, Z. Feuer, S. A. Birken, et al., “National Assessment of Recommendations From Healthcare Providers for Smoking Cessation Among Adults With Cancer,” Cancer Epidemiology 78 (2022): 102088.

[39] S. Lim, L. Schultz, P. Zakko, et al., “The Potential Negative Effects of Smoking on Cervical and Lumbar Surgery Beyond Pseudarthrosis: A Michigan Spine Surgery Improvement Collaborative Study,” World Neurosurgery 173 (2023): e241–e249.

[40] J. Zhou, R. Wang, X. Huo, W. Xiong, L. Kang, and Y. Xue, “Incidence of Surgical Site Infection After Spine Surgery: A Systematic Review and Meta-Analysis,” Spine (Phila Pa 1976) 45, no. 3 (2020): 208–216.

[41] L. Han, H. Han, H. Liu, et al., “Alcohol Abuse and Alcohol Withdrawal Are Associated With Adverse Perioperative Outcomes Following Elective Spine Fusion Surgery,” Spine (Phila Pa 1976) 46, no. 9 (2021): 588–595.

[42] J. W. M. Egholm, B. Pedersen, K. Oppedal, et al., “Minor Effect of Patient Education for Alcohol Cessation Intervention on Outcomes After Acute Fracture Surgery: A Randomized Trial of 70 Patients,” Acta Orthopaedica 93 (2022): 424–431.

[43] J. R. Shaw, E. Kaplovitch, and J. Douketis, “Periprocedural Management of Oral Anticoagulation,” Medical Clinics of North America 104, no. 4 (2020): 709–726.

[44] C. Zhu, B. Wang, Y. Gao, and X. Ma, “Prevalence and Relationship of Malnutrition and Distress in Patients With Cancer Using Questionnaires,” BMC Cancer 18, no. 1 (2018): 1272.

[45] S. Oe, J. Watanabe, T. Akai, et al., “The Effect of Preoperative Nutritional Intervention for Adult Spinal Deformity Patients,” Spine (Phila Pa 1976) 47, no. 5 (2022): 387–395.

[46] S. Wang and L. Wu, “Risk Factors for Venous Thrombosis After Spinal Surgery: A Systematic Review and Meta-Analysis,” Computational and Mathematical Methods in Medicine 2022 (2022): 1621106.

[47] Y. Ellenbogen, R. G. Power, A. Martyniuk, P. T. Engels, S. V. Sharma, and E. M. Kasper, “Pharmacoprophylaxis for Venous Thromboembolism in Spinal Surgery: A Systematic Review and Meta-Analysis,” World Neurosurgery 150 (2021): e144–e154.

[48] B. Tamowicz, A. Mikstacki, T. Urbanek, and K. Zawilska, “Mechanical Methods of Venous Thromboembolism Prevention: From Guidelines to Clinical Practice,” Pol Arch Intern Med 129, no. 5 (2019): 335–341.

[49] B. Tan, C. Xiao, M. Cheng, et al., “A Systematic Review and Meta-Analysis of Elastic Stockings for Prevention of Thrombosis After Orthopedic Surgery,” Ann Palliat Med 10, no. 10 (2021): 10467–10474.

[50] G. H. Lyman and N. M. Kuderer, “Clinical Practice Guidelines for the Treatment and Prevention of Cancer-Associated Thrombosis,” Thrombosis Research 191, no. Suppl 1 (2020): S79–S84.

[51] M. Z. X. Xiao, M. Englesakis, and A. Perlas, “Gastric Content and Perioperative Pulmonary Aspiration in Patients With Diabetes Mellitus: A Scoping Review,” British Journal of Anaesthesia 127, no. 2 (2021): 224–235.

[52] G. P. Joshi, B. B. Abdelmalak, W. A. Weigel, et al., “2023 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting: Carbohydrate-Containing Clear Liquids With or Without Protein, Chewing Gum, and Pediatric Fasting Duration-A Modular Update of the 2017 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting,” Anesthesiology 138, no. 2 (2023): 132–151.

[53] T. J. P. Batchelor, N. J. Rasburn, E. Abdelnour-Berchtold, et al., “Guidelines for Enhanced Recovery After Lung Surgery: Recommendations of the Enhanced Recovery After Surgery (ERAS(R)) Society and the European Society of Thoracic Surgeons (ESTS),” European Journal of Cardio-Thoracic Surgery 55, no. 1 (2019): 91–115.

[54] E. A. Cho, N. H. Lee, J. H. Ahn, W. J. Choi, J. H. Byun, and T. Song, “Preoperative Oral Carbohydrate Loading in Laparoscopic Gynecologic Surgery: A Randomized Controlled Trial,” Journal of Minimally Invasive Gynecology 28, no. 5 (2021): 1086–1094 e1.

[55] X. Liu, P. Zhang, M. X. Liu, J. L. Ma, X. C. Wei, and D. Fan, “Preoperative Carbohydrate Loading and Intraoperative Goal-Directed Fluid Therapy for Elderly Patients Undergoing Open Gastrointestinal Surgery: A Prospective Randomized Controlled Trial,” BMC Anesthesiology 21, no. 1 (2021): 157.

[56] M. Balabolu, K. Abuji, S. L. Soni, et al., “Effect of Preoperative Carbohydrate Drink and Postoperative Chewing Gum on Postoperative Nausea and Vomiting in Patients Undergoing Day Care Laparoscopic Cholecystectomy: A Randomized Controlled Trial,” World Journal of Surgery 47, no. 11 (2023): 2708–2717.

[57] N. K. Chaudhary, D. R. Sunuwar, R. Sharma, et al., “The Effect of Pre-Operative Carbohydrate Loading in Femur Fracture: A Randomized Controlled Trial,” BMC Musculoskeletal Disorders 23, no. 1 (2022): 819.

[58] K. Kotfis, A. Wojciechowska, M. Zimny, et al., “Preoperative Oral Carbohydrate (CHO) Supplementation Is Beneficial for Clinical and Biochemical Outcomes in Patients Undergoing Elective Cesarean Delivery Under Spinal Anaesthesia-A Randomized Controlled Trial,” Journal of Clinical Medicine 12, no. 15 (2023): 4978.

[59] S. L. Chow, C. Sasson, I. J. Benjamin, et al., “Opioid Use and Its Relationship to Cardiovascular Disease and Brain Health: A Presidential Advisory From the American Heart Association,” Circulation 144, no. 13 (2021): e218–e232.

[60] B. A. Baldo, “Toxicities of Opioid Analgesics: Respiratory Depression, Histamine Release, Hemodynamic Changes, Hypersensitivity, Serotonin Toxicity,” Archives of Toxicology 95, no. 8 (2021): 2627–2642.

[61] Z. Zhang, H. Xu, Y. Zhang, et al., “Nonsteroidal Anti-Inflammatory Drugs for Postoperative Pain Control After Lumbar Spine Surgery: A Meta-Analysis of Randomized Controlled Trials,” Journal of Clinical Anesthesia 43 (2017): 84–89.

[62] M. Ekinci, B. Ciftci, E. C. Celik, A. M. Yayik, A. Tahta, and Y. O. Atalay, “A Comparison of the Ultrasound-Guided Modified-Thoracolumbar Interfascial Plane Block and Wound Infiltration for Postoperative Pain Management in Lumbar Spinal Surgery Patients,” Aǧrı 32, no. 3 (2020): 140–146.

[63] R. V. Nielsen, J. S. Fomsgaard, L. Nikolajsen, J. B. Dahl, and O. Mathiesen, “Intraoperative S-Ketamine for the Reduction of Opioid Consumption and Pain One Year After Spine Surgery: A Randomized Clinical Trial of Opioid-Dependent Patients,” European Journal of Pain 23, no. 3 (2019): 455–460.

[64] G. S. Murphy, M. J. Avram, S. B. Greenberg, et al., “Perioperative Methadone and Ketamine for Postoperative Pain Control in Spinal Surgical Patients: A Randomized, Double-Blind, Placebo-Controlled Trial,” Anesthesiology 134, no. 5 (2021): 697–708.

[65] E. C. V. Brinck, K. Maisniemi, J. Kankare, L. Tielinen, P. Tarkkila, and V. K. Kontinen, “Analgesic Effect of Intraoperative Intravenous S-Ketamine in Opioid-Naive Patients After Major Lumbar Fusion Surgery Is Temporary and Not Dose-Dependent: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial,” Anesthesia and Analgesia 132, no. 1 (2021): 69–79.

[66] C. Taylor, A. Metcalf, A. Morales, J. Lam, R. Wilson, and T. Baribeault, “Multimodal Analgesia and Opioid-Free Anesthesia in Spinal Surgery: A Literature Review,” Journal of Perianesthesia Nursing 38, no. 6 (2023): 938–942.

[67] E. M. Soffin, D. S. Wetmore, J. D. Beckman, et al., “Opioid-Free Anesthesia Within an Enhanced Recovery After Surgery Pathway for Minimally Invasive Lumbar Spine Surgery: A Retrospective Matched Cohort Study,” Neurosurgical Focus 46, no. 4 (2019): E8.

[68] A. Ogrenci, E. Akar, O. Koban, et al., “Spinal Anesthesia in Surgical Treatment of Lumbar Spine Tumors,” Clinical Neurology and Neurosurgery 196 (2020): 106023.

[69] J. M. Breton, C. G. Ludwig, M. J. Yang, et al., “Spinal Anesthesia in Contemporary and Complex Lumbar Spine Surgery: Experience With 343 Cases,” Journal of Neurosurgery. Spine 36, no. 4 (2022): 534–541.

[70] A. Y. Wang, M. Olmos, T. Ahsan, et al., “Safety and Feasibility of Spinal Anesthesia During Simple and Complex Lumbar Spine Surgery in the Extreme Elderly (>/=80 Years of Age),” Clinical Neurology and Neurosurgery 219 (2022): 107316.

[71] R. Pranata, M. A. Lim, R. Vania, and T. G. Bagus Mahadewa, “Minimal Invasive Surgery Instrumented Fusion Versus Conventional Open Surgical Instrumented Fusion for the Treatment of Spinal Metastases: A Systematic Review and Meta-Analysis,” World Neurosurgery 148 (2021): e264–e274.

[72] A. N. Baig, S. K. Kishwar Jafri, M. W. Saeed Baqai, and M. S. Shamim, “Endoscopic Surgical Treatment for Primary Spinal Lesions,” Journal of the Pakistan Medical Association 72, no. 10 (2022): 2121–2123.

[73] K. Hireche, M. Moqaddam, N. Lonjon, et al., “Combined Video-Assisted Thoracoscopy Surgery and Posterior Midline Incision for en Bloc Resection of Non-Small-Cell Lung Cancer Invading the Spine,” Interactive Cardiovascular and Thoracic Surgery 34, no. 1 (2022): 74–80.

[74] V. Kotheeranurak, K. Jitpakdee, Y. Pornmeechai, et al., “Posterior Endoscopic Cervical Decompression in Metastatic Cervical Spine Tumors: An Alternative to Palliative Surgery,” J Am Acad Orthop Surg Glob Res Rev 6, no. 11 (2022): e22.00201.

[75] J. J. Zhou, C. Hemphill, C. T. Walker, S. H. Farber, and J. S. Uribe, “Adverse Effects of Perioperative Blood Transfusion in Spine Surgery,” World Neurosurgery 149 (2021): 73–79.

[76] R. la De Garza Ramos, Y. Gelfand, J. A. Benton, et al., “Rates, Risk Factors, and Complications of Red Blood Cell Transfusion in Metastatic Spinal Tumor Surgery: An Analysis of a Prospective Multicenter Surgical Database,” World Neurosurgery 139 (2020): e308–e315.

[77] A. S. Zaw, S. B. Kantharajanna, K. Maharajan, B. Tan, A. A. Saparamadu, and N. Kumar, “Metastatic Spine Tumor Surgery: Does Perioperative Blood Transfusion Influence Postoperative Complications?,” Transfusion 57, no. 11 (2017): 2790–2798.

[78] N. E. Epstein, “When to Stop Anticoagulation, Anti-Platelet Aggregates, and Non-Steroidal Anti-Inflammatories (NSAIDs) Prior to Spine Surgery,” Surgical Neurology International 10 (2019): 45.

[79] U. Barrie, C. A. Youssef, M. N. Pernik, et al., “Transfusion Guidelines in Adult Spine Surgery: A Systematic Review and Critical Summary of Currently Available Evidence,” Spine Journal 22, no. 2 (2022): 238–248.

[80] J. H. Chow, Z. Chancer, M. A. Mazzeffi, et al., “Impact of Preoperative Platelet Count on Bleeding Risk and Allogeneic Transfusion in Multilevel Spine Surgery,” Spine (Phila Pa 1976) 46, no. 1 (2021): E65–E72.

[81] K. Kobayashi, E. Ozkan, A. Tam, J. Ensor, M. J. Wallace, and S. Gupta, “Preoperative Embolization of Spinal Tumors: Variables Affecting Intraoperative Blood Loss After Embolization,” Acta Radiologica 53, no. 8 (2012): 935–942.

[82] A. Reyes-Sanchez, A. Dominguez-Soto, B. Zarate-Kalfopulos, et al., “Single Dose of Tranexamic Acid Effectively Reduces Blood Loss in Patients Undergoing Spine Surgery: A Prospective Randomized Controlled Trial,” World Neurosurgery 175 (2023): e964–e968.

[83] B. Tang, T. Ji, W. Guo, et al., “Which Is the Better Timing Between Embolization and Surgery for Hypervascular Spinal Tumors, the Same Day or the Next Day?: A Retrospective Comparative Study,” Medicine (Baltimore) 97, no. 23 (2018): e10912.

[84] D. Ptashnikov, N. Zaborovskii, D. Mikhaylov, and S. Masevnin, “Preoperative Embolization Versus Local Hemostatic Agents in Surgery of Hypervascular Spinal Tumors,” Int J Spine Surg 8 (2014): 8.

[85] J. H. Yoo, S. Y. Ok, S. H. Kim, et al., “Efficacy of Active Forced Air Warming During Induction of Anesthesia to Prevent Inadvertent Perioperative Hypothermia in Intraoperative Warming Patients: Comparison With Passive Warming, a Randomized Controlled Trial,” Medicine (Baltimore) 100, no. 12 (2021): e25235.

[86] J. H. Yoo, S. Y. Ok, S. H. Kim, et al., “Comparison of Upper and Lower Body Forced Air Blanket to Prevent Perioperative Hypothermia in Patients Who Underwent Spinal Surgery in Prone Position: A Randomized Controlled Trial,” Korean Journal of Anesthesiology 75, no. 1 (2022): 37–46.

[87] W. Muir, “Contemporary Perspectives on Perioperative Fluid Therapy,” Journal of the American Veterinary Medical Association 261, no. 10 (2023): 1539–1546.

[88] J. Elia, M. Diwan, R. Deshpande, J. C. Brainard, and K. Karamchandani, “Perioperative Fluid Management and Volume Assessment,” Anesthesiology Clinics 41, no. 1 (2023): 191–209.

[89] B. Abdelhamid, M. Matta, A. Rady, G. Adel, and M. Gamal, “Conventional Fluid Management Versus Plethysmographic Variability Index-Based Goal Directed Fluid Management in Patients Undergoing Spine Surgery in the Prone Position - a Randomised Control Trial,” Anaesthesiol Intensive Ther 55, no. 3 (2023): 186–195.

[90] F. P. Desgranges, L. Bouvet, E. de Pereira Souza Neto, et al., “Non-Invasive Measurement of Digital Plethysmographic Variability Index to Predict Fluid Responsiveness in Mechanically Ventilated Children: A Systematic Review and Meta-Analysis of Diagnostic Test Accuracy Studies,” Anaesthesia, Critical Care & Pain Medicine 42, no. 3 (2023): 101194.

[91] M. Coutrot, E. Dudoignon, J. Joachim, E. Gayat, F. Vallee, and F. Depret, “Perfusion Index: Physical Principles, Physiological Meanings and Clinical Implications in Anaesthesia and Critical Care,” Anaesth Crit Care Pain Med 40, no. 6 (2021): 100964.

[92] P. Peltoniemi, I. Lehto, P. Pere, H. Mustonen, T. Lehtimaki, and H. Seppanen, “Goal-Directed Fluid Management Associates With Fewer Postoperative Fluid Collections in Pancreatoduodenectomy Patients,” Pancreatology 23, no. 5 (2023): 456–464.

[93] M. Ueno, W. Saito, M. Yamagata, et al., “Triclosan-Coated Sutures Reduce Wound Infections After Spinal Surgery: A Retrospective, Nonrandomized, Clinical Study,” Spine Journal 15, no. 5 (2015): 933–938.

[94] K. Shi, X. Chen, B. Shen, Y. Luo, R. Lin, and Y. Huang, “The Use of Novel Knotless Barbed Sutures in Posterior Long-Segment Lumbar Surgery: A Randomized Controlled Trial,” Journal of Orthopaedic Surgery and Research 17, no. 1 (2022): 279.

[95] S. Oswal, R. Borle, N. Bhola, A. Jadhav, S. Surana, and R. Oswal, “Surgical Staples: A Superior Alternative to Sutures for Skin Closure After Neck Dissection-A Single-Blinded Prospective Randomized Clinical Study,” Journal of Oral and Maxillofacial Surgery 75, no. 12 (2017): 2707 e1–2707 e6.

[96] R. Krishnan, S. D. MacNeil, and M. S. Malvankar-Mehta, “Comparing Sutures Versus Staples for Skin Closure After Orthopaedic Surgery: Systematic Review and Meta-Analysis,” BMJ Open 6, no. 1 (2016): e009257.

[97] M. S. Walid, M. Abbara, A. Tolaymat, J. R. Davis, K. D. Waits, and J. S. Robinson, “The Role of Drains in Lumbar Spine Fusion,” World Neurosurgery 77, no. 3–4 (2012): 564–568.

[98] B. Karamian, P. Kothari, G. Toci, et al., “Effect of Drain Duration and Output on Perioperative Outcomes and Readmissions After Lumbar Spine Surgery,” Asian Spine J 17, no. 2 (2023): 262–271.

[99] R. Andrew Glennie, N. Dea, and J. T. Street, “Dressings and Drains in Posterior Spine Surgery and Their Effect on Wound Complications,” Journal of Clinical Neuroscience 22, no. 7 (2015): 1081–1087.

[100] D. B. Herrick, J. E. Tanenbaum, M. Mankarious, et al., “The Relationship Between Surgical Site Drains and Reoperation for Wound-Related Complications Following Posterior Cervical Spine Surgery: A Multicenter Retrospective Study,” Journal of Neurosurgery. Spine 29, no. 6 (2018): 628–634.

[101] A. V. Gubin, O. G. Prudnikova, K. N. Subramanyam, A. V. Burtsev, M. V. Khomchenkov, and A. V. Mundargi, “Role of Closed Drain After Multi-Level Posterior Spinal Surgery in Adults: A Randomised Open-Label Superiority Trial,” European Spine Journal 28, no. 1 (2019): 146–154.

[102] N. A. Crain, R. Z. Goharderakhshan, N. C. Reddy, A. M. Apfel, and R. A. Navarro, “The Role of Intraoperative Urinary Catheters on Postoperative Urinary Retention After Total Joint Arthroplasty: A Multi-Hospital Retrospective Study on 9,580 Patients,” Arch Bone Jt Surg 9, no. 5 (2021): 480–486.

[103] L. Leitner, F. Wanivenhaus, L. M. Bachmann, et al., “Bladder Management in Patients Undergoing Spine Surgery: An Assessment of Care Delivery,” North American Spine Society Journal 6 (2021): 100059.

[104] A. Ansorge, M. Betz, O. Wetzel, et al., “Perioperative Urinary Catheter Use and Association to (Gram-Negative) Surgical Site Infection After Spine Surgery,” Infectious Disease Reports 15, no. 6 (2023): 717–725.

[105] D. Contartese, F. Salamanna, S. Brogini, et al., “Fast-Track Protocols for Patients Undergoing Spine Surgery: A Systematic Review,” BMC Musculoskeletal Disorders 24, no. 1 (2023): 57.

[106] E. P. M. de Almeida, J. P. de Almeida, G. Landoni, et al., “Early Mobilization Programme Improves Functional Capacity After Major Abdominal Cancer Surgery: A Randomized Controlled Trial,” British Journal of Anaesthesia 119, no. 5 (2017): 900–907.

[107] J. Huang, Z. Shi, F. F. Duan, et al., “Benefits of Early Ambulation in Elderly Patients Undergoing Lumbar Decompression and Fusion Surgery: A Prospective Cohort Study,” Orthopedic Surgery 13, no. 4 (2021): 1319–1326.

[108] S. Lim, M. Bazydlo, M. Macki, et al., “Validation of the Benefits of Ambulation Within 8 Hours of Elective Cervical and Lumbar Surgery: A Michigan Spine Surgery Improvement Collaborative Study,” Neurosurgery 91, no. 3 (2022): 505–512.

[109] H. M. Zakaria, M. Bazydlo, L. Schultz, et al., “Ambulation on Postoperative Day #0 Is Associated With Decreased Morbidity and Adverse Events After Elective Lumbar Spine Surgery: Analysis From the Michigan Spine Surgery Improvement Collaborative (MSSIC),” Neurosurgery 87, no. 2 (2020): 320–328.

[110] D. A. W. Sykes, T. Q. Tabarestani, N. S. Chaudhry, et al., “Awake Spinal Fusion Is Associated With Reduced Length of Stay, Opioid Use, and Time to Ambulation Compared to General Anesthesia: A Matched Cohort Study,” World Neurosurgery 176 (2023): e91–e100.

[111] C. Fachini, C. Z. Alan, and L. V. Viana, “Postoperative Fasting Is Associated With Longer ICU Stay in Oncologic Patients Undergoing Elective Surgery,” Perioperative Medicine (London) 11, no. 1 (2022): 29.

[112] L. Lai, L. Zeng, Z. Yang, Y. Zheng, and Q. Zhu, “Current Practice of Postoperative Fasting: Results From a Multicentre Survey in China,” BMJ Open 12, no. 7 (2022): e060716.

[113] J. W. Kim, Y. G. Park, J. H. Kim, E. C. Jang, and Y. C. Ha, “The Optimal Time of Postoperative Feeding After Total Hip Arthroplasty: A Prospective, Randomized, Controlled Trial,” Clinical Nursing Research 29, no. 1 (2020): 31–36.

[114] A. C. Franco, A. Bicudo-Salomao, J. E. Aguilar-Nascimento, T. B. Santos, and R. V. Sohn, “Ultra-Early Postoperative Feeding and Its Impact on Reducing Endovenous Fluids,” Revista do Colégio Brasileiro de Cirurgiões 47 (2020): e20202356.

[115] T. Schlesinger, P. Meybohm, and P. Kranke, “Postoperative Nausea and Vomiting: Risk Factors, Prediction Tools, and Algorithms,” Current Opinion in Anaesthesiology 36, no. 1 (2023): 117–123.

[116] W. Zhao, J. Li, N. Wang, et al., “Effect of Dexmedetomidine on Postoperative Nausea and Vomiting in Patients Under General Anaesthesia: An Updated Meta-Analysis of Randomised Controlled Trials,” BMJ Open 13, no. 8 (2023): e067102.

[117] J. Schwartz and T. J. Gan, “Management of Postoperative Nausea and Vomiting in the Context of an Enhanced Recovery After Surgery Program,” Best Practice & Research. Clinical Anaesthesiology 34, no. 4 (2020): 687–700.

[118] R. Souchon, F. Wenz, F. Sedlmayer, et al., “DEGRO Practice Guidelines for Palliative Radiotherapy of Metastatic Breast Cancer: Bone Metastases and Metastatic Spinal Cord Compression (MSCC),” Strahlentherapie und Onkologie 185, no. 7 (2009): 417–424.

[119] D. Choi, A. Crockard, C. Bunger, et al., “Review of Metastatic Spine Tumour Classification and Indications for Surgery: The Consensus Statement of the Global Spine Tumour Study Group,” European Spine Journal 19, no. 2 (2010): 215–222.

[120] L. Scaramuzzo, A. Perna, C. Velluto, M. I. Borruto, F. L. Gorgoglione, and L. Proietti, “Rethinking Strategies for Multi-Metastatic Patients: A Comprehensive Retrospective Analysis on Open Posterior Fusion Versus Percutaneous Osteosynthesis in the Treatment of Vertebral Metastases,” Journal of Clinical Medicine 13, no. 11 (2024): 3343.

[121] F. Li, W. Yu, H. Zhou, et al., “Construction and Development of an Enhanced Recovery After Surgery Program for the Surgical Management of Patients With Spinal Metastasis: A Modified Delphi Study,” Orthopedic Surgery 17, no. 3 (2025): 939–952.

RIGHTS & PERMISSIONS

2026 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.