Implementing a standardized perioperative care program can enhance clinical practices for elderly patients undergoing lumbar fusion surgery (LFS). Multimodal prehabilitation and Enhanced recovery after surgery (ERAS) protocols are extensively employed as evidence-based protocols for a continuous perioperative management across various surgical fields. The aim of this study is to utilize the Delphi method, a validated consensus-building technique, reach a consensus among a panel of Chinese experts on the essential components of prehabilitation and ERAS for older patients undergoing elective LFS.The study utilized a 3-round modified Delphi method to reach a consensus among Chinese experts. The process involves the establishment of a core group and expert panel, questionnaire development and distribution, independent scoring by experts, an online meeting for discussion and revision of scores, and final statistical analysis of the results.A total of 30 experts major in spine surgery, anesthesia, nursing, and geriatrics were invited from 14 different provinces and cities across China to participate in the survey. After two rounds of expert surveys and one online meeting discussion, the final protocols included 23 elements, with an approval rate that exceeded 80%.Using a modified Delphi process, we developed a comprehensive protocol that combines pre-rehabilitation and ERAS for elderly patients undergoing elective LFS encompassing 23 different interventions. The multidisciplinary experts recommend incorporating these measures into the perioperative care for elderly patients undergoing LFS surgery.Copyright © 2025. Published by Elsevier Inc.