48 Enhanced recovery after surgery for patients with adolescent idiopathic scoliosis (AIS) undergoing posterior spinal fusion. (15th December 2021) - Wilson, Lauren
Abstract : Background: The benefits of using an Enhanced Recovery after Surgery (ERAS) protocol are recognised in adults but, until recently, there has been little evidence in paediatrics. Posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) can be associated with significant pain and prolonged hospitalisation. An ERAS pilot was conducted in these patients using historical controls as a baseline. The primary outcome was length of hospital stay (LOS), and secondary outcomes time to full mobility, resumption of diet and pain scores. Methods: No ethical approval was required as the pilot was considered a service evaluation. A multidisciplinary working group analysed the entire patient journey and formulated an evidence-based protocol focused on improving the outcomes for each element. Historical control data from the electronic patient management system included all patients with AIS who had undergone PSF from May 2019 to April 2020. A pilot using the ERAS pathway in patients with AIS undergoing PSF was implemented in March 2021. Results: Historical data was available for 30 patients compared to 16 patients in the pilot. Use of the ERAS pathway was associated with a reduction in median LOS of 1 day [range 0–9 days] (5 days [range 4–8 days] vs. 6 days [range 4–17 days]). There was a gain of at least 1 day across mobility goals and 2 days for urinary catheter removal with no change in patients' pain scores or complications. Discussion: The pilot supports the use of an ERAS programme with regard to LOS and functional recovery, number of hospital bed days saved and ability for increased patient throughput. Further focused work will improve outcomes even further. Conclusion: Implementation of an ERAS programme for patients with AIS undergoing PSF has the potential for reducing variability and optimising the Trust's spinal service, impacting positively on both patients and the hospital.