Enhanced recovery after spine surgery: state of the art in the Russian Federation

Abstract

Objective. To analyze the attitude of neurosurgeons to the technology of enhanced recovery after spine and spinal cord surgery in the Russian Federation.Material and Methods. In March 2022, a continuous cohort comparative sociological study was conducted among 83 neurosurgeons of the Russian Federation, during which they were asked to fill out a specially designed online questionnaire consisting of 22 questions on the Google Forms platform.Results. The vast majority of respondents (95.2 %) noted the lack of information in the Russian literature on the technology of enhanced recovery after surgery (ERAS). Nevertheless, most neurosurgeons, regardless of specialization, are familiar with the terms “fast track” (79.5 %) and “ERAS” (60.2 %). Only 44.6 % of specialists declared the implementation of ERAS recommendations into their daily clinical practice, while 78.3 % of neurosurgeons draw attention to the existence of problems that hamper adoption of enhanced recovery protocols (ERP) in Russia. The interviewed respondents are confident that it is possible to introduce ERP into spinal neurosurgery in adults (91.6 %) and children (85.5 %) in Russia. Every second respondent (50.6 %) considers it possible to directly extrapolate foreign ERP into clinical practice in Russian healthcare. Spinal neurosurgeons are more aware of ERAS than cerebral neurosurgeons (p = 0.017), and they also more often use elements of ERAS in their clinical practice (p = 0.002). In other parameters, the respondents did not differ significantly depending on their specialization. Only 7.2 % of interviewed neurosurgeons work in private clinics. All of them are engaged in spinal surgery and introduce the ERAS technology into their clinical practice. Less than half (40.0 %) of neurosurgeons in public clinics implement elements of the ERAS (p = 0.007). More than half (69.7 %) of specialists and every second manager consider the introduction of ERAS in a neurosurgical clinic to be progressive, and only a few of them (3.6 %), on the contrary, believe that the quality of medical care may decrease with the introduction of ERAS. Neurosurgeons (n = 13) identified 7 clinics of the Russian Federation, where the enhanced recovery protocol after spine surgery is implemented. In total, according to the results of the study, 23 elements of the ERAS protocol are implemented in the practice of respondents (n = 20) in the conditions of Russian healthcare.Conclusions. Despite the lack of publications in the Russian literature and the existing organizational problems in the context of domestic healthcare, neurosurgeons have a positive attitude towards the introduction of ERAS protocol into clinical practice. This protocol or its individual elements are already successfully implemented in a group of clinics in Russia.