Ask an answerable question (PICO)：
Patients may harbor concerns regarding the necessity for extended hospitalization when contemplating surgery, potentially giving rise to clinical apprehensions. Employing empirical evidence as a foundation, our objective is to investigate whether "Enhanced Recovery After Surgery" (ERAS) can effectively mitigate the duration of hospitalization for individuals undergoing surgery for spinal stenosis.
The Method and Analysis of Literature Review：
Search Strategy:In this study, the search was conducted using the following keywords: "P" for spinal stenosis/spinal deformity, "I"(Intervention) for Enhanced Recovery After Surgery (ERAS), "C"(Compare) for traditional care, and "O" (Outcomes) for length of stay/length in hospital. The databases searched included PubMed, CINAHL, and Cochrane Library. Boolean logic was applied, using OR for vertical linking between PICO elements and AND for horizontal linking. Natural language and synonyms were incorporated for a comprehensive systematic literature search. The search was limited to articles published between 2018 and 2022 in English, encompassing systematic reviews (SR) and randomized controlled trials (RCT).
Screening Process:Initially, 790 articles were collected, and 115 duplicates were removed. After screening titles and abstracts, 664 articles not relevant to the topic were excluded. Six articles did not meet the inclusion criteria and were consequently excluded. Additionally, four SR full-text articles were excluded due to redundancy with included articles. Ultimately, one SR and one RCT were included in the analysis.
Critical Appraisal：
The first article, classified as Level 1 evidence, is a systematic review analyzing 21 studies, including 12 retrospective studies, 8 prospective studies, and 1 randomized controlled trial (RCT). It aimed to compare the length of hospital stay for spinal surgery patients under Enhanced Recovery After Surgery (ERAS). The review concluded that ERAS led to shorter hospital stays, reduced readmissions, decreased reoperations, lower blood loss, and shorter surgery durations.
The second article, a Level 2 evidence RCT with 38 patients undergoing open lumbar laminectomy, assessed the impact of multimodal anesthesia on hospital stay. The RCT found a significant reduction in hospital stay for patients receiving multimodal anesthesia.
In summary, both articles support the positive impact of ERAS or multimodal anesthesia on spinal surgery patients' hospital stay, indicating improved recovery. The systematic review provides a broader perspective, while the RCT contributes more focused evidence.
Clinical Application of Evidence：
This study involves 40 participants, with 20 in the experimental group and 20 in the control group. Prior to admission, outpatient physicians advise all patients to quit smoking and alcohol consumption and introduce them to the treatment process.
During hospitalization, the experimental group receives detailed guidance on Enhanced Recovery After Surgery (ERAS) from nurses, covering fasting, postoperative pain management, drainage tube care, mobilization timing, and back brace use. The anesthesiologist explains anesthesia processes, surgery medications, and a multimodal pain management approach to prevent postoperative pain.
The goal is to actively prepare patients before surgery, optimize treatment during surgery, and encourage proactive recovery. The control group follows standard care. The study aims to assess the impact of enhanced interventions on postoperative recovery, pain management, and patient satisfaction.
Evaluation of Effectiveness：
The experimental group, though not significantly different in hospitalization duration from the control group, showed a reduction (6.6 days vs. 7.3 days). On the day of surgery, the experimental group reported a lower pain score (3.1) compared to the control group (4.7). Significant differences were observed in postoperative feeding time (p=0.000), with the experimental group able to eat almost immediately, whereas the control group typically started on the first or second day. Postoperative ambulation time also showed a significant difference (p=0.046), as the experimental group could get out of bed on the second or third day, while the control group mostly required until the third day. These findings suggest potential benefits associated with the enhanced intervention in terms of pain management, postoperative feeding, and ambulation times.
Conclusions and Recommendations：
The experimental group experienced higher out-of-pocket expenses, particularly for pain relief and antiemetic medications (approximately 30,000 to 35,000), compared to the control group. Despite this, applying Enhanced Recovery After Surgery (ERAS) empirically based on literature regarding preoperative education, early postoperative extubation, and ambulation resulted in a significant reduction in hospital stay. Patients responded positively, leading to increased satisfaction levels.
However, some patients, hesitant due to the presence of tubes, required additional encouragement from nursing staff to engage in postoperative activities. While clinical personnel need to adapt to the new care model, the overall effectiveness of ERAS has been affirmed and aligns with future trends. This approach can potentially extend to other orthopedic procedures. Given the involvement of multiple departments, collaborative research across departments is recommended for future studies.
