Nicholas D Fletcher1, Joshua S Murphy2, Thomas M Austin3, Robert W Bruce2, Hilary Harris2, Patricia Bush4, Austin Yu5, Hirofumi Kusumoto6, Michael L Schmitz2, Dennis P Devito2, Jorge A Fabregas2, Firoz Miyanji7. 1. Department of Orthopaedic Surgery, Center for Advanced Pediatrics, Children's Healthcare of Atlanta, 1400 Tullie Rd, Atlanta, GA, 30329, USA. Nicholas.d.fletcher@emory.edu. 2. Department of Orthopaedic Surgery, Center for Advanced Pediatrics, Children's Healthcare of Atlanta, 1400 Tullie Rd, Atlanta, GA, 30329, USA. 3. Department of Anesthesiology, Children's Healthcare of Atlanta, Atlanta, GA, USA. 4. Department of Emergency Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA. 5. Albany Medical College, Albany, NY, USA. 6. Tulane University School of Medicine, New Orleans, LA, USA. 7. British Columbia Children's Hospital, Vancouver, BC, USA.
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.
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.
Authors: P S Myles; J O Hunt; C E Nightingale; H Fletcher; T Beh; D Tanil; A Nagy; A Rubinstein; J L Ponsford Journal: Anesth Analg Date: 1999-01 Impact factor: 5.108
Authors: K Aaron Shaw; Brittany Ange; Varghese George; Joshua S Murphy; Nicholas D Fletcher Journal: J Am Acad Orthop Surg Glob Res Rev Date: 2022-03-11