Researchers conducted a retrospective study sought to determine the relative effectiveness of the most commonly used components of enhanced recovery after surgery (ERAS) combinations. The Premier Healthcare claims database (2006–2016) was used to extract cases of posterior lumbar fusion. Multimodal analgesia, tranexamic acid, antiemetics on the day of surgery, early physical therapy, no urine catheter, no patient-controlled analgesia, and no wound drains were identified as typically included components in spine ERAS protocols. Length of stay, “any problem,” blood transfusion, and hospitalization cost were the outcomes. From 2006–to 2012 and from 2013–to 2016, mixed-effects models examined the relationships between the most common ERAS combinations and outcomes. The results were presented as odds ratios (ORs) and 95% CIs. ERAS component changes reduced over time in 97,419 (74%; 2006–2012) and 34,932 (26%; 2013–2016) cases, respectively. Multimodal analgesia, antiemetics, early physical therapy, avoidance of a urinary catheter, patient-controlled analgesia, and drainage were the most regularly utilized combinations (10% n=9401 and 19% n=6635, respectively) and did not include tranexamic acid. Multivariable models found modest differences amongst ERAS combinations in terms of duration of stay and expenses. From 2006–to 2012, the second most regularly used ERAS combination(s) had the most pronounced positive effects in terms of blood transfusion (OR: 0.65; CI: 0.59−0.71) and “any complication” (OR: 0.73; CI: 0.66−0.80), both P<0.05. In 2013–2016, the third most regularly used ERAS combination, blood transfusion, had the largest effect: OR: 0.63; CI: 0.50–0.78, P<0.05. ERAS component variances decreased over time, with the greatest advantages evident in lowering transfusion and complication risk. The data could help to guide future ERAS use and clinical trials comparing different ERAS procedures.
