Early Postoperative Nutritional Management Under a Validated Diabetes-Specific Enhanced Recovery After Surgery Protocol in Patients With Lumbar Spinal Stenosis and Type 2 Diabetes Mellitus.

Objective

To evaluate early postoperative nutritional management with a diabetes-specific enhanced recovery after surgery (DS-ERAS) pathway in patients with lumbar spinal stenosis (LSS) and type 2 diabetes mellitus (T2DM).

Methods

This retrospective cohort study compared a DS-ERAS nutritional pathway with conventional perioperative care in LSS patients with T2DM. Outcomes included postoperative recovery, nutritional status, glycemic control, inflammation, complications, and hospital stay. Effect size metrics (relative risk reduction [RRR], absolute risk difference [ARD], number needed to treat [NNT]), subgroup analyses, and multivariable linear regression were performed.

Results

The DS-ERAS group demonstrated faster gastrointestinal recovery, improved nutritional status and glycemic control, reduced inflammatory and shorter hospital stay (p < 0.001). The complication rate was lower (10.0% vs. 23.3%; p = 0.016), with a relative risk reduction of 57.1% and absolute risk difference of 13.3%. Subgroup analyses demonstrated consistent benefits across age, sex, body mass index (BMI), diabetes duration, and surgical segments (all P for interaction > 0.05). Multivariable regression show that DS-ERAS was associated with a mean reduction in hospital stay of 1.57 days.

Conclusion

Early postoperative nutritional management within the DS-ERAS pathway was associated with improved perioperative recovery in LSS patients with T2DM, with favorable nutritional , metabolic, inflammatory, and clinical outcomes.