Enhanced recovery after surgery (ERAS) in adolescent idiopathic scoliosis (AIS): a meta-analysis and systematic review

Abstract

Study design A systematic review reporting on the efficacy of an ERAS protocol in patients undergoing spinal fusion for AIS. Objective To systematically evaluate the relevant literature pertaining to the efficacy of ERAS protocols with respect to the length of stay, complication, and readmission rates in patients undergoing posterior spinal corrective surgery for AIS. Summary of background data ERAS is a multidisciplinary approach aimed at improving outcomes of surgery by a specific evidence-based protocol. The rationale of this rapid recovery regimen is to maintain homeostasis so as to reduce the postoperative stress response and pain. No thorough review of available information for its use in AIS has been published. Methods A systematic review of the English language literature was undertaken using search criteria (postoperative recovery AND adolescent idiopathic scoliosis) using the PRISMA guidelines (Jan 1999-May 2020). Isolated case reports and case series with < 5 patients were excluded. Length of stay (LOS), complication and readmission rates were used as outcome measures. Statistical analysis was done using the random effects model. Results Of a total of 24 articles, 10 studies met the inclusion criteria (9 were Level III and 1 of level IV evidence) and were analyzed. Overall, 1040 patients underwent an ERAS-type protocol following posterior correction of scoliosis and were compared to 959 patients following traditional protocols. There was a significant reduction in the length of stay in patients undergoing ERAS when compared to traditional protocols (p < 0.00001). There was no significant difference in the complication (p = 0.19) or readmission rates (p = 0.30). Each protocol employed a multidisciplinary approach focusing on optimal pain management, nursing care, and physiotherapy. Conclusion This systematic review demonstrates advantages with ERAS protocols by significantly reducing the length of stay without increasing the complications or readmission rates as compared to conventional protocols. However, current literature on ERAS in AIS is restricted largely to retrospective studies with non-randomized data, and initial cohort studies lacking formal control groups. Level of evidence 3.

The outcome of enhanced recovery after surgery vs. a traditional pathway in adolescent idiopathic scoliosis surgery: A retrospective comparative study

“…Based on the advanced experience of previous studies and the characteristics of young patients, we set a multidepartment protocol for AIS surgery including spine surgeon, nurse, anesthetist, psychiatrist, and nutritionist ( 19 , 20 ). For preoperative preparation, the main goals are performing comprehensive assessment, optimizing the nutritional, psychological, and cardiopulmonary function status, alleviating the tension between patients and their families, and making good communication between doctors and patients.…”

Timely completion of spinal fusion: A multidisciplinary quality improvement initiative to improve operating room efficiency

“…Surgical procedure was the most difficult stage to influence; however, situational awareness led to early surgeon presence and assistance with surgical closure. Time needed for fluoroscopy was minimized by checking screw placement only after all screws were in place; however, use of power tools (instead of freehand screw placement) may further improve procedural efficiency 21 . Improved IONM communication and standardized emergence allowed quicker emergence while maintaining analgesia 15 …”

“…18 This was Time needed for fluoroscopy was minimized by checking screw placement only after all screws were in place; however, use of power tools (instead of freehand screw placement) may further improve procedural efficiency. 21 Improved IONM communication and standardized emergence allowed quicker emergence while maintaining analgesia. 15 Improving scheduling accuracy has been shown to be important to OR efficiency.…”

Enhanced recovery after surgery (ERAS) protocol in spine surgery

“…19 A meta-analysis relating to Adolescent idiopathic scoliosis (AIS) also found a reduced LOS in the ERAS group. 10 Liu et al in their RCT on 94 patients with intraspinal tumors noted a significant reduction in LOS, lower postoperative pain scores, decreased patient controlled analgesia use and opioid use, early removal of urinary catheter and higher satisfaction rates in the ERAS group. However, the complication rates were not different between the two groups.…”