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Enhanced recovery after surgery (ERAS) in sacral tumour surgery and comprehensive description of a multidisciplinary program: a prospective study in a specialized hospital in China

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Abstract

Purpose

There were fewer data to guide the application of enhanced recovery after surgery (ERAS) theory into sacral tumour surgery. In the present study, we were aiming to describe a multidisciplinary program of ERAS and evaluate the availability in sacral tumour surgery.

Methods

This was a prospective study of patients with sacral tumour between March 2021 and September 2021 at a single centre. We proposed a multidisciplinary program of ERAS for pre-admission, preoperative, intraoperative, postoperative, and post-discharge clinical care which positively influenced outcomes of patients with sacral tumour. All patients were prospectively assigned into two groups, ERAS group in which patients received ERAS protocols (n = 63), No-ERAS group in which patients had conventional clinical pathways (n = 62). Patient data were collected which included demographics, preoperative preparation, detailed information of surgical procedure, 60-day reoperation rate, 60-day readmission, postoperative length of stay (PLOS), time to first ambulation and flatus after surgery, time to removal of last drainage tube, and visual analogue scale (VAS) score at first ambulation and discharge. Complications referred to ones that occurred within 60 days after surgery. The above parameters were compared between ERAS group and No-ERAS group.

Results

Time to first ambulation after surgery in ERAS group (mean 20.9 h) was significantly shorter than that in No-ERAS group (mean 104.3 ho). Meanwhile, time to first flatus after surgery in ERAS group (mean 26.7 h) was also significantly shorter than that in No-ERAS group (mean 37.3 h). Patients in ERAS group had statistically shorter PLOS (10.7 days) as compared to that in No-ERAS group (13.8 days). In ERAS group, 19 of 63 patients (30.2%) were discharged within seven days after surgery as compared to seven of 62 patients (11.3%) in No-ERAS group. VAS score at first ambulation in ERAS group was not obviously higher than that in No-ERAS group though the time of first ambulation in ERAS group was statistically earlier than one in No-ERAS group. Furthermore, VAS score at discharge in ERAS group was significantly lower than that in No-ERAS group. The rate of postoperative incision necrosis was 6.3% (4/63) in ERAS group and 8.1% (5/62) in No-ERAS group and all of these nine patients underwent reoperation before discharge. The difference was not statistically significant in the wound complication of incision necrosis and 60-day reoperation rate. Only one readmission occurred in No-ERAS group due to the surgical site infection and also there was no significant difference of 60-day readmission rate between these two groups. Furthermore, there was no statistical difference of complications of femoral artery thrombosis and rectal rupture between ERAS group and No-ERAS group.

Conclusions

Our proposed ERAS pathway for sacral tumour surgery and early walking facilitate safe and prompt discharge. ERAS protocols of sacral tumour surgery could decrease PLOS without significantly increasing postoperative complications, 60-day readmission rate and 60-day reoperation rate. The application of ERAS pathway in the field of sacral tumour surgery should have personalized feature with regard to resection type.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Code availability

SPSS software during the current study is available from the corresponding author on reasonable request.

Funding

This work was supported by Natural Science Foundation of China (NO: 82272947), Peking University People’s Hospital Research and Development Funds (NO: RDG2021-02, RDL2022-14, RZ2023-02), and Clinical Medicine Plus X-Young Scholars Project, Peking University, the Fundamental Research Funds for the Central Universities (NO: PKU2023LCXQ016).

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Authors and Affiliations

  1. Peking University People’s Hospital, Musculoskeletal Tumor Center, No. 11 Xizhimen South Street, Beijing, 100044, China

    Jun Wang, Dasen Li, Yi Yang, Lei Zhang, Wei Guo & Xiaodong Tang

  2. Department of Radiology, Peking University People’s Hospital, No. 11 Xizhimen South Street, Beijing, 100044, China

    Chen Chen

  3. Department of Anesthesiology, Peking University People’s Hospital, No. 11 Xizhimen South Street, Beijing, 100044, China

    Junjun Xu & Fei Huo

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  1. Jun Wang
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Contributions

JW (contribution: collect and analyze data and draft the article)

CC (contribution: collect data and take charge of preoperative SAE)

DL(contribution: collect and analyze data)

YY (contribution: collect and analyze data)

JX (contribution: collect data and take charge of anesthesia)

LZ (contribution: collect data and take charge of nursing)

FH (contribution: collect data and take charge of anesthesia)

WG (contribution: perform surgery and study design)

XT (contribution: perform surgery and study design)

Corresponding authors

Correspondence to Jun Wang, Chen Chen, Wei Guo or Xiaodong Tang.

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Informed consent was obtained from all individual participants included in the study.

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Jun Wang and Chen Chen are co-first authors.

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Wang, J., Chen, C., Li, D. et al. Enhanced recovery after surgery (ERAS) in sacral tumour surgery and comprehensive description of a multidisciplinary program: a prospective study in a specialized hospital in China. International Orthopaedics (SICOT) 48, 581–601 (2024). https://doi.org/10.1007/s00264-023-06016-0

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