Enhanced Recovery After Surgery Pathway: Association with Lower Incidence of Wound Complications and Severe Hypoalbuminemia in Patients Undergoing Posterior Lumbar Fusion Surgery

Background. Wound complications were associated with worse satisfaction and additional costs in patients underwent posterior lumbar fusion(PLF) surgery ,the relationship between enhanced recovery after surgery(ERAS)pathway and wound complications remains poorly characterized.Methods. In this retrospective single-center study, we compared 530 patients receiving ERAS pathway care with previous 530 patients in non-ERAS group. The primary aim of our study was to identify the relationship between ERAS program and the incidence of postoperative wound related complications and other complications following PLF surgery, other outcomes included the length of stay(LOS), 90-day hospital and rehabilitation center readmission.Results. Average patient age was 65yr. There were more patients with old cerebral infarction in ERAS group (p<0.01), other demographics and comorbidities were similar between both groups. Patients in ERAS group had a lower incidence of postoperative wound-related complications compared with non-ERAS group(12.4 vs 17.8%, p=0.02).The non-ERAS group had a significantly higher rate of wound dehiscence or poor wound healing(6% vs 3%, p=0.02). ERAS group had a lower incidence of server postoperative hypoalbuminemia(serum albumin less than 30g/L)(15.8% vs 9.0% p<0.01).Additionally, ERAS patients had a shorter postoperative LOS (8.0±1.5 vs 9.5±1.7 p<0.01), lower rate of readmission within 90 days (1.9% vs 6.4%, p<0.01) and discharge to rehabilitation center (4.2% vs 1.0%, p<0.01).Conclusion. ERAS pathway may help to decrease the rates of postoperative wound complications and server hypoalbuminemia following PLF surgery, additionally, we demonstrated that ERAS pathway was also associated with shorter LOS and lower rate of readmissions within 90-day.

The Effect of Lower-Limb Exercise on Pain Management of the Patients Undergoing Posterior Lumbar Fusion Surgery: A Retrospective Case-Control Study

Purpose. The purpose of this study is to investigate the clinical effect of lower-limb exercise, when combined with celecoxib, on pain management of patients undergoing posterior lumbar fusion surgeries. Methods. The patients undergoing posterior lumbar fusion surgeries between 01/2018 and 06/2021 were retrospectively identified, with their data collected. After surgery, some patients took celecoxib for analgesia (celecoxib group, 200 mg/day) while the others took celecoxib together with lower-limb exercise (combined group, celecoxib-200 mg/day). On postoperative days (POD) 1, 3, 7, and 14, data were collected and analyzed regarding the following items: patient satisfaction, lower-limb muscle force, lumbar JOA score (29 points), Oswestry Disability Index (ODI), and visual analog scale (VAS) score. Results. A total of 225 participants were included in this study. Specifically, 120 cases were admitted into in the celecoxib group and 105 were included in the combined group. Comparisons of baseline data did not indicate any difference between the combined group and the celecoxib group. Data analysis showed that patient satisfaction in the combined group was significantly higher than the celecoxib group on POD 3, 7, and 14, respectively (all p < 0.001 ). Moreover, the combined group had less VAS score compared with the celecoxib group on POD 3, 7, and 14, respectively (all p < 0.01 ). In addition, lower-limb muscle force in the combined group was significantly stronger than that in the celecoxib group on POD 3 and POD 7, respectively (both p < 0.01 ). Furthermore, the combined group achieved less ODI score than the celecoxib group on POD 3, 7, and 14, respectively (all p < 0.05 ). Comparisons of the lumbar JOA score did not suggest any statistical difference during the whole follow-up period. Conclusions. In conclusion, postoperative lower-limb rehabilitation exercise can help to release pain after lumbar fusion surgeries. Additionally, postoperative lower-limb exercise can facilitate the recovery of lower-limb muscle force, as well as improving patient satisfaction.

The use of incisional vacuum-assisted closure system following one-stage incision suture combined with continuous irrigation to treat early deep surgical site infection after posterior lumbar fusion with instrumentation

Background Previous reports concerning deep surgical site infection (SSI) after posterior spinal instrumentation treated with vacuum-assisted closure (VAC) system indicated that most patients must suffer from a delayed incision suture. To date, there are no published reports about the application of incisional VAC following a one-stage incision suture in the treatment of spinal infections. The purpose of this study was to evaluate the feasibility and efficacy of using an incisional VAC system following a one-stage incision suture combined with continuous irrigation to treat early deep SSI after posterior lumbar fusion with instrumentation. Methods Twenty-one patients who were identified as early deep SSI after posterior lumbar fusion with instrumentation were treated by incisional VAC following a one-stage incision suture combined with continuous irrigation at our spine surgery center between January 2014 and March 2020. Detailed data from medical records were collected and analyzed, including age, gender, primary diagnosis, original operation, number of VAC dressing changes, duration of continuous irrigation, hospital stay, risk factors for infection, bacteria type, and laboratory data. Clinical efficacy was assessed using the pre- and postoperative visual analog scale (VAS) for back pain and Kirkaldy-Willis functional criteria by regular follow-up. Results All the patients were cured and retained implants with an average of 1.9 times of VAC dressing replacement, and an average of 10.2 days of continuous irrigation. There were significant differences between pre-operation and post-operation in ESR, CRP, and VAS score of back pain, respectively (P < 0.05). The satisfactory rate was 90.5% according to Kirkaldy-Willis functional criteria. One patient developed a back skin rash with itching around the wound because of long-time contact with the VAC dressing. There was no recurrent infection or other complications during follow-up. Conclusions Our preliminary results support that the treatment protocol is feasible and effective to treat early deep SSI following posterior lumbar fusion with instrumentation.