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

• Published in: Spine deformity Vol. 9; no. 4; pp. 1013 - 1019
• Main Authors: Fletcher, Nicholas D., Murphy, Joshua S., Austin, Thomas M., Bruce, Robert W., Harris, Hilary, Bush, Patricia, Yu, Austin, Kusumoto, Hirofumi, Schmitz, Michael L., Devito, Dennis P., Fabregas, Jorge A., Miyanji, Firoz
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.07.2021
• Subjects: Case Series; Medicine; Medicine & Public Health; Orthopedics; Enhanced recovery after surgery; Adolescent idiopathic scoliosis; Posterior spinal fusion; Spinal fusion pathway
• ISSN: 2212-134X; 2212-1358
• DOI: 10.1007/s43390-020-00282-3

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.