Currently, the enhanced recovery after surgery (ERAS) for spinal surgery field is still in its beginnings, the major protocol lessons learned from other surgical specialties and lack of ERAS program for elderly patients (>70 years old). Geriatric patients have its own special characteristics resulting in more harmed by surgical stress. ERAS are designed to improving recovery after surgery and can result in substantial benefits in both clinical outcomes and cost-effectiveness. In the present study, we aimed to determine whether enhanced recovery after surgery (ERAS) significantly improved satisfaction and outcomes in elderly patients (>70 years old) with long-level lumbar fusion.The study enrolled lumbar disc herniation or lumbar spinal stenosis patients if they were over the age of 70 years old underwent lumbar fusion three or more than three levels from July 2019 to June 2021 (ERAS group), and from January 2018 to June 2019 (non-ERAS group). Data including demographic, comorbidity and surgical information were collected from electronic medical records. ERAS interventions were categorised as preoperative, intraoperative and postoperative. We also evaluated primary outcome, surgical complication and length of stay (LOS).A total of 154 patients were included, 72 in the ERAS group and 82 case-matched patients in the non-ERAS group. Overall, ERAS pathway compliance was 91%. There were no significant differences in the readmission and mortality rates at 30-day follow-up between the ERAS and non-ERAS groups. However, we observed a statistically significant decrease in the complications in the ERAS group (6 in the ERAS group versus 19 in the non-ERAS group, p=0.013) and LOS in the ERAS group (17.74±5.56 of ERAS group versus 22.13±12.21 in non-ERAS group, p=0.041). Multivariable linear regression showed that implementation of ERAS program (p=0.002) was correlated with LOS. Multivariable logistic regression showed that implementation of ERAS program (p=0.004) was correlated with complications.This report describes the first ERAS protocol used in elderly patients after long-level lumbar fusion surgery. Our ERAS program is safe and associated with incremental benefits with respect to complications and LOS with long-level lumbar fusion.Copyright © 2022. Published by Elsevier Inc.