Evidence-based practice of enhanced recovery after surgery in spinal surgery: Comprehensive insights into perioperative care and outcome improvement

Enhanced recovery after surgery protocols, first proposed in the late 1990s, represent a multimodal and interdisciplinary framework for surgical management and perioperative care, with nursing involvement as a pivotal component. The application of enhanced recovery after surgery in cranial and spinal neurosurgery has advanced rapidly, with 89.01% of relevant publications emerging in the past 5 years. However, research on its implementation in this subfield remains immature. This narrative review focuses on the development of fast-track surgery, refinement of enhanced recovery after surgery protocols in spinal surgery, and the roles of nursing within enhanced recovery after surgery. Key perioperative interventions include preoperative personalized education, smoking cessation (≥4 weeks), nutritional support, prehabilitation, and preemptive analgesia; intraoperative tranexamic acid use, rational antibiotic administration, standardized or minimally invasive surgery, and goal-directed fluid therapy; and postoperative multimodal analgesia and early mobilization. Clinical evidence confirms that these interventions collectively reduce postoperative complication rates, shorten hospital stay, alleviate pain, and improve prognosis, with nurses playing a central role in enhanced recovery after surgery implementation across all phases. In conclusion, successful enhanced recovery after surgery adoption in spinal surgery relies on multidisciplinary collaboration, and evidence-based individualized care is critical for optimizing recovery. Future studies should focus on refining guidelines to promote enhanced recovery after surgery standardization and broader application.