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.
Similar content being viewed by others
References
Yoshihara H, Yoneoka D (2014) National trends in spinal fusion for pediatric patients with idiopathic scoliosis: demographics, blood transfusions, and in-hospital outcomes. Spine (Phila Pa 1976) 39(14):1144–1150
Fletcher ND, Shourbaji N, Mitchell PM, Oswald TS, Devito DP, Bruce RW (2014) Clinical and economic implications of early discharge following posterior spinal fusion for adolescent idiopathic scoliosis. J Child Orthop 8(3):257–263
Fletcher ND, Andras LM, Lazarus DE et al (2017) Use of a novel pathway for early discharge was associated with a 48% shorter length of stay after posterior spinal fusion for adolescent idiopathic scoliosis. J Pediatr Orthop 37(2):92–97
Gornitzky AL, Flynn JM, Muhly WT, Sankar WN (2016) A rapid recovery pathway for adolescent idiopathic scoliosis that improves pain control and reduces time to inpatient recovery after posterior spinal fusion. Spine Deform 4(4):288–295
Muhly WT, Sankar WN, Ryan K et al (2016) Rapid recovery pathway after spinal fusion for idiopathic scoliosis. Pediatrics 137:4
Sanders A, Andras L, Sousa T, Kissinger C, Cucchiaro G, Skaggs DL (2016) Accelerated discharge protocol for posterior spinal fusion (PSF) patients with adolescent idiopathic scoliosis (AIS) decreases hospital post-operative charges 22. Spine (Phila Pa 1976)
Sanders AE, Andras LM, Sousa T, Kissinger C, Cucchiaro G, Skaggs DL (2017) Accelerated discharge protocol for posterior spinal fusion patients with adolescent idiopathic scoliosis decreases hospital postoperative charges 22. Spine (Phila Pa 1976) 42(2):92–97
Rao RR, Hayes M, Lewis C et al (2017) Mapping the road to recovery: shorter stays and satisfied patients in posterior spinal fusion. J Pediatr Orthop 37(8):e536–e542
Boylan MR, Riesgo AM, Chu A, Paulino CB, Feldman DS (2019) Costs and complications of increased length of stay following adolescent idiopathic scoliosis surgery. J Pediatr Orthop B 28(1):27–31
Myles PS, Hunt JO, Nightingale CE et al (1999) Development and psychometric testing of a quality of recovery score after general anesthesia and surgery in adults. Anesth Analg 88(1):83–90
Brooke MH, Fenichel GM, Griggs RC et al (1989) Duchenne muscular dystrophy: patterns of clinical progression and effects of supportive therapy. Neurology 39(4):475–481
Oetgen ME, Martin BD, Gordish-Dressman H, Cronin J, Pestieau SR (2018) Effectiveness and sustainability of a standardized care pathway developed with use of lean process mapping for the treatment of patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis. J Bone Jt Surg Am 100(21):1864–1870
Raudenbush BL, Gurd DP, Goodwin RC, Kuivila TE, Ballock RT (2017) Cost analysis of adolescent idiopathic scoliosis surgery: early discharge decreases hospital costs much less than intraoperative variables under the control of the surgeon. J Spine Surg 3(1):50–57
Rhodes L, Nash C, Moisan A et al (2015) Does preoperative orientation and education alleviate anxiety in posterior spinal fusion patients? A prospective, randomized study. J Pediatr Orthop 35(3):276–279
Voepel-Lewis T, Caird MS, Tait AR et al (2018) A cluster of high psychological and somatic symptoms in children with idiopathic scoliosis predicts persistent pain and analgesic use 1 year after spine fusion. Paediatr Anaesth 28(10):873–880
Miyanji F, Newton PO, Samdani AF et al (2015) Impact of surgical waiting-list times on scoliosis surgery: the surgeon’s perspective. Spine (Phila Pa 1976) 40(11):823–828
Miyanji F, Slobogean GP, Samdani AF et al (2012) Is larger scoliosis curve magnitude associated with increased perioperative health-care resource utilization?: a multicenter analysis of 325 adolescent idiopathic scoliosis curves. J Bone Jt Surg Am 94(9):809–813
Shen M, Jiang H, Luo M et al (2017) Comparison of low density and high density pedicle screw instrumentation in Lenke 1 adolescent idiopathic scoliosis. BMC Musculoskelet Disord 18(1):336
Samdani AF, Bennett JT, Singla AR et al (2015) Do ponte osteotomies enhance correction in adolescent idiopathic scoliosis? An analysis of 191 lenke 1A and 1B curves. Spine Deform 3(5):483–488
Urbach DR (2017) Delivering timely surgery in Canadian hospitals. CMAJ 189(27):E903–E904
Funding
No funding was received.
Author information
Authors and Affiliations
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
Ethics declarations
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.
Ethical approval
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.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
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 9, 1013–1019 (2021). https://doi.org/10.1007/s43390-020-00282-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s43390-020-00282-3