Construction and Development of an Enhanced Recovery After Surgery Program for the Surgical Management of Patients With Spinal Metastasis: A Modified Delphi Study

Objective: As an effective treatment for spinal metastasis (SM), ERAS protocol can significantly reduce the length of hospital stay and complications in patients. Establishing an ERAS program for perioperative care after SM surgery is a clinical problem that needs to be addressed urgently. We aimed to develop an Enhanced Recovery After Surgery (ERAS) program and Surgical Safety Checklist (SSC) that conferred clinical benefit to patients with SM and made it relatively easy to manage the condition. We believe that our findings could help establish and promote the continuous improvement of additional ERAS programs for SM.

Methods: This is a modified Delphi study. We used a two-round process using data acquired from a review of relevant literature and involving a multidisciplinary panel of experts from different hospitals in China. The modified Delphi survey was conducted from February 1, 2024 to April 20, 2024. The experts were invited to evaluate each of the current relevant ERAS recommended topics to determine the appropriateness of inclusion in the ERAS program and SSC with the 5-point Likert scale. Used the results to create specific ERAS and SSC (70% consensus) programs. Close to consensus (65%-69% consensus) findings were considered for the follow-up survey.

Results: A multicenter, multidisciplinary group of physicians (n = 75), including clinical workers, researchers, anesthesiologists, nursing specialists, psychologists, nutritionists, and caregivers, with experience in managing patients with SM, were asked to participate. Using the modified Delphi process, we arrived at a consensus for the ERAS program. This included 37 consolidated items in the domains in the following order: preoperative, intraoperative, postoperative, and discharge. The SSC included 37 consolidated items in the domains in the following order: before the induction of anesthesia, before skin incision, and before the patient leaves the operating room.

Conclusion: This study, based on the modified Delphi process, helped us develop ERAS and SCC consensus-driven best practice recommendations, including suggestions related to perioperative anesthesia, surgery, and nursing for SM. We hope that this study, in which we integrated both traditional Chinese and Western medical treatment protocols, can provide a basis for a rapid rehabilitation program for surgical interventions in SM.