Short term outcomes of an enhanced recovery after surgery (ERAS) pathway versus a traditional discharge pathway after posterior spinal fusion for adolescent idiopathic scoliosis

Abstract

Purpose

Enhanced Recovery after Surgery (ERAS) pathways have been shown to decrease length of stay (LOS) after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). The aim of this study was to compare immediate post-operative outcomes following an ERAS pathway with a traditional pathway for AIS.

Methods

A prospective dual-center study of patients treated using an ERAS pathway (203 patients) or a traditional discharge (TD) pathway (73 patients) was performed with focus on pain at discharge, quality of life at one month, and return to school/work.

Results

LOS was 55% less in the ERAS group (4.8 days TD vs. 2.2 days ERAS, p < 0.001). Length of surgery (4.8 h TD vs. 2.8 h, p < 0.001) and EBL (500 cc vs. 240 cc, p < 0.001) were greater in the TD group, likely related to larger curve magnitudes ((62.0° TD vs. 54.0° ERAS, p < 0.001), a higher percentage of patients undergoing osteotomies (94% vs. 46%, p < 0.001) and more levels fused (11.4 ± 1.6 vs. 10.1 ± 2.6, p < 0.001) in the TD group. Regression analysis showed no difference in Visual Analog Score (VAS) score at discharge or quality of recovery using the QOR9 instrument between groups at follow up. There was no difference in return to school (p = 0.43) and parents’ return to work (p = 0.61) between the groups.

Conclusion

Patients managed with an ERAS pathway had similar pain scores at discharge than those managed with a TD pathway. Both groups showed evidence of rapid return to normalcy by the first follow up visit.

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Funding

No funding was received.

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Authors

Contributions

F: study design, data collection/analysis, manuscript preparation, manuscript revision and approval. M: study design, data collection/analysis, manuscript preparation, manuscript revision and approval. A: data collection/analysis, manuscript preparation, manuscript revision and approval. B: study design, manuscript preparation, manuscript revision and approval. H: data collection/analysis, manuscript revision and approval. B: study design, data collection/analysis, manuscript revision and approval. Y: data collection/analysis, manuscript revision and approval. K: data collection/analysis, manuscript revision and approval. S: study design, manuscript preparation, manuscript revision and approval. D: manuscript preparation, manuscript revision and approval. F: manuscript preparation, manuscript revision and approval. M: study design, data collection/analysis, manuscript revision and approval.

Corresponding author

Correspondence to Nicholas D. Fletcher.

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Conflicts of interest

Nicholas D. Fletcher, MD—Consultant: Orthopaediatrics, Medtronic, Nuvasive; Speaker’s Bureau: Orthopaediatrics and Zimmer Biomet; Research support: Harrison Foundation and Stryker Spine through Setting Scoliosis Straight/Harms Study Group. Joshua S. Murphy, MD—Speaker’s Bureau: Orthopaediatrics and Depuy/Synthes. Thomas Austin, MD/MS—None. Robert W. Bruce Jr., MD—None. Hilary Harris – None. Patricia Bush EdD—None. Austin Yu—None. Hirofumi Kusumoto—None. Michael Schmitz, MD—Consultant: Stryker Spine and Orthopediatrics. Dennis Devito, MD—Consultant: Medicrea, Astura Spine, Sea Spine; Advisory board: Stryker Spine and Medtronic; Royalties: Medicrea Spine; Astura Spine; Sea Spine; Research: Stryker Spine and Medicrea. Jorge Fabregas, MD—None. Firoz Miyanji—Consultant: Depuy/Synthes, Orthopaediatrics, Zimmer/Biomet; Grant Support: Setting Scoliosis Straight.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Fletcher, N.D., Murphy, J.S., Austin, T.M. et al. Short term outcomes of an enhanced recovery after surgery (ERAS) pathway versus a traditional discharge pathway after posterior spinal fusion for adolescent idiopathic scoliosis. Spine Deform (2021). https://doi.org/10.1007/s43390-020-00282-3

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Keywords

  • Adolescent idiopathic scoliosis
  • Posterior spinal fusion
  • Enhanced recovery after surgery
  • Spinal fusion pathway