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Peng Cui,1– 3 Peng Wang,1– 3 Chao Kong,1– 3 Xiang Yu Li,1– 3 Shuai Kang Wang,1– 3 Jia Lin Wang,1– 3 Xu Liu,1– 3 Shi Bao Lu1– 3 1Department of Orthopedics, Xuanwu Hospital Capital Medical University, Beijing, People’s Republic of China; 2National Clinical Research Center for Geriatric Diseases, Beijing, People’s Republic of China; 3Capital Medical University, Beijing, People’s Republic of ChinaCorrespondence: Shi Bao Lu, Email spinelu@163.comPurpose: To compare pain scores (visual analog scale) on postoperative days 1– 3 and length of stay after implementing enhanced recovery after surgery (ERAS) in elderly patients undergoing multi-segments lumbar fusion surgery.Methods: We performed a retrospective analysis of prospectively collected data, patients older than 75 years were enrolled in the study. We selected two periods, before (Pre-ERAS, n =54 patients) and after (ERAS, n =46 patients) implementation of ERAS. Data were collected on patient demographics, operative and perioperative details, 30-day readmission. The primary outcome was the length of stay (LOS), and the secondary outcomes were postoperative mean pain scores on postoperative days (POD) 1– 3 and 30-day readmission rates.Results: A total of 100 patients (46 in ERAS and 54 in pre-ERAS) were enrolled in this study. There were no significant differences in age, sex, body mass index (BMI), smoking and comorbidities between the groups. However, there was a significant difference in pain on postoperative day (POD) 1 (5.31 ± 1.98 vs 4.37 ± 0.85, p = 0.002), while there was no difference in postoperative complications. The mean LOS was significantly shorter in the ERAS than in the pre-ERAS group, it reduced from 12.29 ± 3.93 to 9.45 ± 2.72 days (p < 0.001).Conclusion: To our knowledge, this is the first ERAS protocol used in patients (older than 75 years) undergoing polysegmental lumbar fusion surgery. Pain scores on POD 1 and LOS were significantly lower without increased adverse events after implementation of ERAS. This finding suggests that elderly people (> 75 years of age) undergoing polysegmental lumbar fusion surgery could also benefit from ERAS.Keywords: enhanced recovery after surgery, elderly, multi-segment, lumbar fusion surgery