Clinical Study On The Application Of Accelerated Rehabilitation Surgery Concept To Lumbar Spinal Stenosis Surgery

Objective: Low Back Pain(LBP)is one of the common complaints of patients in orthopedics department,and Lumbar Degenerative Diseases causing back pain(LBP),Lumbar Interbody Fusion(LIF)is mainly Lumbar Spinal Stenosis(LSS)pathological type,and most patients are treated surgically after conservative and ineffective,which is often lumbar interbody Fusion(LIF).LIF is typically performed using five Lumbar approaches,including Posterior Lumbar Interbody Fusion(PLIF),Transforaminal Interbody Fusion(transforaminal Interbody Fusion,TLIF),Lateral Lumbar Interbody Fusion(LLIF),Oblique Lumbar Interbody Fusion(LLIF),Oblique Lumbar Interbody Fusion,OLIF)and Anterior Lumbar Interbody Fusion(ALIF).Although the outcome after LIF is usually good,some patients still experience perioperative adverse events that affect the entire recovery process from the disease.Enhanced Recovery After Surgery(ERAS)is an evidence-based multidisciplinary,multi-modal approach designed to reduce the incidence of adverse reactions to surgical stress and surgery-related complications,shorten hospital stays,and accelerate the recovery process.In this study,the safety,feasibility,effectiveness and economic benefits of ERAS philosophy in patients receiving PLIF were analyzed by comparison with traditional philosophy.Methods: A total of 60 patients diagnosed with LSS and admitted to the People’s Hospital of Baise City,Guangxi Province from October 2020 to October 2022 were retrospectively included,including 34 female patients and 26 male patients.Patients were classified into ERAS group(n=31)and conventional group(n=29)according to whether accelerated rehabilitation surgery protocol was applied in perioperative period.All patients in ERAS group signed informed consent for ERAS process.General data such as age,sex,Body Mass Index(BMI),disease duration and surgical fusion segment were collected from the two groups.Data related to perioperative and post-discharge follow-up were collected,including Visual Analogue Scale(VAS)scores and Oswestry Disfunction Index(ODI)scores at different time points before and after surgery.Intraoperative blood loss and intraoperative blood transfusion;The occurrence of postoperative complications and readmission of patients were recorded,and the hospitalization cost and postoperative hospital stay of patients were collected.The above data were sorted out and analyzed by SPSS 26.0.The normal distribution measurement data were described by x±s using two-independent sample t test.The non-normal distribution measurement data were described by(M(P25,P75))using the rank-sum test of two independent samples.Counting data were tested by chi-square test.The test level α value was 0.05 on both sides,and P<0.05 was considered statistically significant.Results:(1)There was no significant difference in gender,age,BMI,duration of disease and surgical fusion segment between the two groups(P>0.05).(2)Intraoperative blood loss,intraoperative blood transfusion and postoperative length of hospital stay between the two groups,the intraoperative blood loss(300(200,500)),intraoperative blood transfusion(0(0,245))and postoperative length of hospital stay(6(5,7)in ERAS group were significantly better than those in the conventional group(500(425,900)),intraoperative blood transfusion(0(0,590))and postoperative hospitalization days(10(9,12)),the difference was statistically significant(Z=-3.317,-1.895,-6.477,P<0.05).Compared with the total hospitalization days and hospitalization costs of the two groups,the total hospitalization days(11.87±2.08)and hospitalization costs(7.33±1.53)of ERAS group were superior to the total hospitalization days(14.97±2.46)and hospitalization costs(7.67±2.11)of the conventional group(t=-5.281,-0.629,P<0.05).(3)There were no significant differences in preoperative VAS and ODI scores between 2 groups(t=0.229,-0.452,P>0.05).VAS(4.99±0.45)and ODI(52.69±1.54)on postoperative day 1 and VAS(3.25±0.35)and ODI(41.66±1.68)on postoperative day 2 in ERAS group.VAS(1.86±0.19)and ODI(41.66±1.68)on day 3 after surgery were better than those in conventional group(5.43±0.68)and ODI(57.06±1.43)on day 1 after surgery,and VAS(3.82±0.57)and ODI(46.78±1.30)on day 2 after surgery,respectively.VAS(2.91±0.20)and ODI(38.46±0.41)on the 3rd day after surgery were statistically significant(P<0.05).There were no significant differences in VAS and ODI scores 1 month after surgery between the two groups(t=-0.279,-0.145,P>0.05).VAS and ODI scores in each postoperative period were significantly lower than those before surgery,with statistical significance(P<0.05).(4)There were no serious complications such as segmental positioning error,vascular and nerve injury,dural sac tear,nerve root tear,and cerebrospinal fluid leakage in all patients.However,one case of oral hematoma was found in ERAS group with an incidence of 3.2%,while two cases of oral hematoma and one case of lower limb venous thrombosis were found in conventional group with an incidence of 10.3%.Chi-square test and Fisher’s exact probability method were used.There were no significant differences in the incidence of postoperative oral hematoma,complications of lower limb venous thrombosis and readmitted rates(χ2=0.004,0.001,0.344,P>0.05).Conclusion:(1)PLIF combined with ERAS in the perioperative period is practical,feasible and effective in the diagnosis of LSS.(2)In this study,on the basis of achieving the same efficacy as the traditional diagnosis and treatment mode,ERAS can also reduce the physiological and psychological discomfort of patients in the perioperative period,reduce intraoperative blood loss,effectively relieve postoperative pain,and not increase the incidence of postoperative complications,shorten postoperative hospital stay,reduce hospitalization costs,and significantly improve the perioperative quality of life of patients.It is beneficial to improve lumbar function and accelerate postoperative rehabilitation.