Recent Evidence in Enhanced Recovery After Surgery Implementation

Key Findings: This systematic review and metaanalysis assessed studies published on enhanced recovery after surgery (ERAS) in spine surgery across both high-income countries (HICs) and lowmiddle-income countries (LMICs).The researchers were particularly interested in length of stay (LOS) and cost savings with ERAS implementation.The initial search resulted in 1232 articles.After refining the search for those that met the criteria, the analysis included 83 LOS studies and 20 cost comparison studies.A significant reduction in LOS was observed in both HICs (-2.06 days; 95% CI, -2.47 to 1.64) and LMICs (-0.99 days; 95% CI, -1.28 to -0.70).Low-middle-income countries were more likely to implement preoperative optimization measures (OR, 2.14; 95% CI, 1.06 to 4.41) and to study operation time (OR, 3.78; 95% CI, 1.77 to 8.35).Of note, the pooled analysis did not demonstrate statistically significant cost benefits with ERAS implementation.Significance: The analysis showed that ERAS has sustained a global presence in the field of spine surgery, and the number of spine ERAS-related studies published by researchers in LMICs continues to grow.In this meta-analysis, 26 countries were represented, 58% and 42% of which represented HICs and LMICs, respectively.The authors were interested to see how the varying availability of different medication, technology, and resources might influence ERAS adoption in countries of different economic status.This analysis did not reveal any stark differences.In both settings, barriers to ERAS implementation included staff shortages, a lack of metric-tracking infrastructure, and poor communication between multidisciplinary health care providers and between providers and patients.Most of the research was retrospective, had small sample sizes (