Effect of an ERAS Nursing Protocol on Recovery After Minimally Invasive Lumbar Fusion: A Randomized Trial.

BACKGROUND: Perioperative care for minimally invasive lumbar interbody fusion (MIS-LIF) is often suboptimal. Evidence for nurse-led Enhanced Recovery After Surgery (ERAS) protocols in this population is lacking. Our study was to evaluate the impact of a structured nursing management protocol based on ERAS principles on postoperative recovery outcomes in patients undergoing MIS-LIF for lumbar spinal stenosis. METHODS: In a prospective randomized controlled trial, 70 patients scheduled for single-level MIS-LIF were randomly assigned to either an ERAS group (n = 35) or a conventional care group (n = 35). The ERAS group received a structured nursing protocol encompassing preoperative education, preemptive analgesia, intraoperative temperature and fluid management, postoperative multimodal analgesia, staged early mobilization, and complication prevention; the conventional care group received routine perioperative care based on standard orders. The protocol was implemented from admission to discharge. The primary outcome was time to first ambulation. Secondary outcomes included length of stay, pain scores (NRS at 6, 24, 48, 72 h), opioid consumption, complications, ODI (preoperative, discharge, 1 month), and patient satisfaction (at discharge). RESULTS: The time to first ambulation was significantly earlier in the ERAS group (P < 0.001). The ERAS group also had a shorter hospital stay, lower pain scores, reduced opioid consumption (all P < 0.001), a lower overall complication rate (P = 0.002) with fewer episodes of nausea/vomiting (P = 0.016), superior functional improvement (ODI: 38.2±6.8 vs. 45.6±7.5, P < 0.001), and higher satisfaction at discharge (P < 0.001). CONCLUSION: A nurse-led ERAS protocol safely and effectively accelerates recovery, improves pain management, reduces complications, patient satisfaction after MIS-LIF.