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Zach Pennington, Ethan Cottrill, Daniel Lubelski, Jeff Ehresman, Kurt Lehner, Mari L. Groves, Paul Sponseller, and Daniel M. Sciubba

. Enhanced recovery after surgery (ERAS) pathways are now being applied to both adult 9 , 10 and pediatric spine surgery populations. 11–17 Despite the growing body of evidence, no quantitative review exists summarizing the existing literature on outcomes of pediatric spinal deformity ERAS protocols. To address this, we report a systematic review of the literature on ERAS for pediatric scoliosis to 1) identify the components of previously described pediatric spine ERAS protocols; 2) determine whether ERAS protocols reduce LOS, complication rates, and costs in pediatric

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Yuan Wang, Bolin Liu, Tianzhi Zhao, Binfang Zhao, Daihua Yu, Xue Jiang, Lin Ye, Lanfu Zhao, Wenhai Lv, Yufu Zhang, Tao Zheng, Yafei Xue, Lei Chen, Eric Sankey, Long Chen, Yingxi Wu, Mingjuan Li, Lin Ma, Zhengmin Li, Ruigang Li, Juan Li, Jing Yan, Shasha Wang, Hui Zhao, Xude Sun, Guodong Gao, Yan Qu, and Shiming He

C onventional craniotomy is typically associated with significant physiological stressors and prolonged functional recovery. An excessive stress response can predispose patients to an increased risk of cardiovascular and cerebrovascular complications, nutrient malabsorption, and delayed convalescence. 33 With our increasing understanding of perioperative pathophysiology, the concept of enhanced recovery after surgery (ERAS), introduced by Kehlet in 1997, has been established in an effort to improve functional outcomes after surgery and decrease perioperative

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G. Damian Brusko, John Paul G. Kolcun, Julie A. Heger, Allan D. Levi, Glen R. Manzano, Karthik Madhavan, Timur Urakov, Richard H. Epstein, and Michael Y. Wang

L umbar spinal fusion can be highly successful in properly selected patients, and numerous studies have documented improvements in metrics designed to measure health outcomes and quality of life improvements following surgery. 10 However, these procedures typically involve a lengthy recovery period that is associated with significant pain, immobility, and economic cost. The majority of patients will overcome this recovery period to resume their normal lives; however, the burden of surgical intervention remains significant. The enhanced recovery after surgery

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Ebru Tarıkçı Kılıç, Tuncay Demirbilek, and Sait Naderi

effect of intraoperative infusion of dexmedetomidine on the quality of recovery after major spinal surgery . J Neurosurg Anesthesiol 25 : 16 – 24 , 2013 10.1097/ANA.0b013e31826318af 22824921 2 Carli F : Physiologic considerations of Enhanced Recovery After Surgery (ERAS) programs: implications of the stress response . Can J Anaesth 62 : 110 – 119 , 2015 10.1007/s12630-014-0264-0 25501695 3 Dunn LK , Durieux ME , Nemergut EC : Non-opioid analgesics: Novel approaches to perioperative analgesia for major spine surgery . Best Pract Res Clin

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Michael Y. Wang, Peng-Yuan Chang, and Jay Grossman

T he Enhancing Recovery After Surgery (ERAS) movement began in Denmark as a practice concept integrating multidisciplinary, perioperative care programs. Previously known as “fast-track surgery” or “enhanced recovery programs,” it started to gain ground in the 1990s by aiming to reduce the length of hospitalization after elective abdominal surgery through integrated approaches to maintain cardiovascular, pulmonary, neurological, gastrointestinal, and endocrine homeostatic functions. 9 , 10 Traditionally, a patient's surgical journey has been broken into

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Dong Hwa Heo and Choon Keun Park

: The expandable transforaminal lumbar interbody fusion—two years follow-up . J Craniovertebr Junction Spine 9 : 50 – 55 , 2018 29755237 2 Brantigan JW , Steffee AD : A carbon fiber implant to aid interbody fusion. Two-year clinical results in the first 26 patients . Spine (Phila Pa 1976) 18 : 2106 – 2107 , 1993 8272967 10.1097/00007632-199310001-00030 3 Chang HK , Kolcun JPG , Chang PY , Wang MY : Enhanced Recovery After Surgery™ awake minimally-invasive transforaminal lumbar interbody fusion: 2-dimensional operative video . Oper Neurosurg

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Ellen M. Soffin, Douglas S. Wetmore, Lauren A. Barber, Avani S. Vaishnav, James D. Beckman, Todd J. Albert, Catherine H. Gang, and Sheeraz A. Qureshi

, : Pre-optimization of spinal surgery patients: development of a neurosurgical enhanced recovery after surgery (ERAS) protocol . Clin Neurol Neurosurg 164 : 142 – 153 , 2018 10.1016/j.clineuro.2017.12.003 29232645 2 Anderson PA , Subach BR , Riew KD : Predictors of outcome after anterior cervical discectomy and fusion: a multivariate analysis . Spine (Phila Pa 1976) 34 : 161 – 166 , 2009 10.1097/BRS.0b013e31819286ea 19139666 3 Apfel CC , Zhang K , George E , Shi S , Jalota L , Hornuss C , : Transdermal scopolamine for the prevention

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Victor E. Staartjes, Marlies P. de Wispelaere, and Marc L. Schröder

. References 1 Ali ZS , Ma TS , Ozturk AK , Malhotra NR , Schuster JM , Marcotte PJ , : Pre-optimization of spinal surgery patients: Development of a neurosurgical enhanced recovery after surgery (ERAS) protocol . Clin Neurol Neurosurg 164 : 142 – 153 , 2018 10.1016/j.clineuro.2017.12.003 29232645 2 Chang HK , Kolcun JPG , Chang PY , Wang MY : Enhanced Recovery After Surgery™ awake minimally-invasive transforaminal lumbar interbody fusion: 2-dimensional operative video . Oper Neurosurg (Hagerstown) [epub ahead of print], 2018 [Erratum in

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Vikram B. Chakravarthy, Hana Yokoi, Daniel J. Coughlin, Mariel R. Manlapaz, and Ajit A. Krishnaney

T he current healthcare climate focuses on evidence-based medicine that is efficient, safe, and cost-effective. Therefore, many surgical centers place greater emphasis on standardized protocols designed to maximize patient outcomes among all surgical specialties. Between 2004 and 2015, the number of elective lumbar fusions increased by 62.3% and was especially high among patients older than 65 years (138.7%). Overall hospital costs also increased by 177% during this period, exceeding $10 billion in 2015. 40 Enhanced recovery after surgery (ERAS) protocols

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Zach Pennington, Ethan Cottrill, Daniel Lubelski, Jeff Ehresman, Nicholas Theodore, and Daniel M. Sciubba

I n an effort to reduce variability, improve outcomes, and reduce cost in spinal surgery, there has been a recent drive to identify care pathways that result in consistently good, cost-effective outcomes for patients. This drive has led to the development of Enhanced Recovery After Surgery (ERAS) pathways, which were first described as “fast-track surgery” in the cardiac surgery literature in the 1990s. 1 ERAS pathways are defined by the ERAS Society as any perioperative care pathway designed to accelerate patient recovery after major surgery. 2 Elements of