Authors (including presenting author) :
Wong KS(1), Wong WK(1), Lam WY(1), Chan WH(1), Tse YN(1), Yip WP(1)
Affiliation :
(1)Department of Orthopaedics and Traumatology, Tseung Kwan O Hospital
Keyword 1: :
Enhanced Recovery After Surgery
Keyword 3: :
Lumbar Spinal Fusion
Keyword 4: :
Early Mobilisation
Keyword 5: :
Perioperative Nursing
Introduction :
Enhanced Recovery After Surgery (ERAS) protocols have successfully reduced Length of Stay (LOS) for total knee replacements in our cluster since 2018. However, the adoption of similar protocols for spinal surgery remains limited locally. Significant variances in perioperative care persist, highlighting the need to align clinical practice with international best standards to improve efficiency and recovery.
Objectives :
This project aimed to bridge the gap between current clinical practice and evidence-based standards for elective lumbar spinal fusion. The primary objectives were to establish baseline performance metrics through a retrospective audit and to identify effective, evidence-based interventions to optimise patient outcomes and resource utilisation.
Methodology :
Conducted by the O&T nursing team, this project comprised two distinct tasks. First, a retrospective case review of 43 elective lumbar fusion cases performed between 2019 and 2023 was conducted. This audit comprehensively analysed patient demographics, operative profiles, and perioperative recovery markers, inclusive of analgesia modalities, mobilisation timing, catheter duration, and discharge outcomes. Second, the team utilised the Johns Hopkins Evidence-Based Practice (EBP) model to conduct a systematic literature review. The specific PICO question formulated was: "In patients undergoing elective lumbar spinal fusion surgery, does the implementation of an Enhanced Recovery After Surgery (ERAS) approach compared to conventional perioperative care result in a significant reduction in length of hospital stay, decreased rates of readmission, and fewer postoperative complications?". A total of 25 retrieved studies were then appraised for strength and quality prior to synthesis.
Result & Outcome :
The retrospective review identified specific opportunities for process optimisation when compared to ERAS standards, noting a mean LOS of 25.2 days, ambulation commencing on mean postoperative day 5.9, and urinary catheter duration averaging 7.3 days. Conversely, the evidence synthesis revealed overwhelming consistency across quasi-experimental, non-experimental, and clinical guideline studies that comprehensive ERAS protocols significantly reduce postoperative LOS. Strong evidence identified early mobilisation (within 24 hours) as a critical independent driver of improved outcomes. Furthermore, the review confirmed that success relies on a "bundled" approach, where multimodal opioid-sparing analgesia and standardised patient education act as essential facilitators. Integrating these findings, the project serves as the pivotal evidence base for an ERAS (spine) task force established in December 2025. This input is currently guiding the development of a standardised protocol specifically targeting Day 0 mobilisation to optimise perioperative recovery.
