ERAS guideline in development for cervical neck decompression surgery

Editor's note

Enhanced Recovery After Surgery (ERAS) guidelines continue to evolve for specific procedures with the goal to optimize patient recovery and surgical outcome. There is a recognized need for consensus on ERAS recommendations specific to surgery for moderate to severe degenerative cervical myelopathy (DMC)—progressive compression of the spinal cord in the neck, according to recent protocol description for developing ERAS recommended for DCM surgery published November 8 in Spinal Cord.

DCM is a common type of non-traumatic spinal procedure. However, it represents wide variation in short term outcomes such as length of stay and discharge destination and is associated with several known complications, per the article. These complications can include hardware complications and neurological injury or dural tears, as well as cerebrovascular and thromboembolic events, urinary tract infections, and pneumonia.

Protocol authors described work to develop an ERAS guideline on optimal multidisciplinary care for patients undergoing surgery for DCM that address pre-operative, perioperative and early post-operative care spanning through 4 weeks after surgery. They acknowledged known unmet care needs for this surgical population, including pain management, patient education and shared decision making.

Specifically, the protocol is designed to cover several specific approaches to ERAS guideline development for DCM surgical patients, including:

*Defining patient candidates and research questions for ERAS interventions
*Selecting and rating the importance of outcomes for each ERAS candidate intervention
*Summarizing and judging the quality and strength of evidence for each ERAS candidate intervention
*Developing recommendation statements for the included ERAS interventions

A final draft of the guideline is planned to be published in a peer reviewed journal and also made available for free or open-access download via the ERAS society website where current specialty-specific ERAS guidelines for a number of procedures can be found.