Enhanced Recovery After Surgery — better known as ERAS — has become the perioperative buzzword of the decade. Faster recovery, fewer opioids, shorter hospital stays…what’s not to love? But how widely are ERAS principles actually being used in lumbar fusion surgery across the globe?
A recent international survey of spine surgeons offers a fascinating glimpse into what surgeons believe matters most — and where the real-world gaps still exist.
A Global Spine Surgery Pulse Check
In May 2024, investigators sent a web-based survey to members of AOSpine, asking surgeons about the importance of eight key ERAS components outlined in the 2021 lumbar fusion perioperative care consensus statement.
The response rate was impressive: 400 surgeons opened the survey. 322 responded (80.5%) and 76.7% completed the full questionnaire.
Respondents represented a broad spectrum of practice environments: Academic centers: 50.6%; private practice: 28.9%, and community hospitals: 20.5%.
The ERAS “Big Three”
When surgeons were asked which ERAS components have the biggest impact on recovery after lumbar fusion, three clear winners emerged:
- Multimodal opioid-sparing analgesia (73%): No surprise here. With the opioid crisis still looming large, most spine surgeons recognize the value of combining analgesic strategies — regional blocks, NSAIDs, acetaminophen, gabapentinoids, and other non-opioid options — to keep narcotics to a minimum.
- Early mobilization (64%): The old-school “stay in bed for a few days” mentality is fading fast. Surgeons increasingly recognize that getting patients up and moving — sometimes the same day — can accelerate recovery and reduce complications.
- Preoperative education and counseling (59%): Apparently, one of the most powerful surgical tools isn’t in the operating room — it’s in the pre-op clinic. Preparing patients for what to expect after surgery appears to have a major influence on recovery trajectories.
So far, so good. Surgeons clearly understand what matters.
Here Are Also the Weakest Links
Ironically, when surgeons were asked where the most improvement is needed, the same three components topped the list. Preoperative education: 62.6% said improvement needed. Early mobilization: 41.4% and Multimodal analgesia: 39.4%.
In other words, spine surgeons know exactly what works…but many admit they’re not consistently delivering it.
The Real Barriers: It’s Not the Surgeons
So, what’s getting in the way? The biggest obstacles weren’t skepticism or resistance from surgeons themselves.
Instead, the barriers were largely system-level issues: Lack of clear protocols and guidelines – 56%. Staff shortages – 54%, and difficulty coordinating ERAS implementation – 43%.
Surgeons may want ERAS, but implementing it requires team coordination — nursing, anesthesia, physical therapy, and hospital administration all rowing in the same direction.
Changing surgical technique is easy. Changing hospital systems? Not so much.
The Takeaway for Spine Surgeons
This survey highlights an interesting paradox in modern spine care. The science of enhanced recovery is widely accepted, but the execution remains inconsistent.
For hospitals looking to improve lumbar fusion outcomes, the message is clear: the next gains won’t come from a new implant or surgical approach. They’ll come from better perioperative systems.
Origin Study Title: Enhanced Recovery After Lumbar Fusion Surgery: An International Survey on Current Practice
Authors: Hein H. R. Jonkman, HJ, M.D., MSc; Floris R. van Tol, FT, M.D., Ph.D.; Tim M. Govers, TG, Ph.D.; Silje A. C. A. Debets, SD, MSc; Thomas W. Wainwright, TW, Ph.D.; Bertrand Debono, BD, M.D., Ph.D.; Michael M. H. Yang, MY, M.D., Ph.D.; Hans D. de Boer, HdB, M.D., Ph.D.; Maroeska M. Rovers, MR, Ph.D.; Jorrit-Jan Verlaan, JJV, M.D., Ph.D.