Enhanced recovery after surgery (ERAS) for adolescent idiopathic scoliosis: Standardisation of care improves patient outcomes

Julien Pico; Chrystelle Sola; Anne Charlotte Saour; Kevin Chapron; Lucie Coruble; Sophie Bringuier; Christophe Dadure

doi:10.1016/j.accpm.2022.101116

Enhanced recovery after surgery (ERAS) for adolescent idiopathic scoliosis: Standardisation of care improves patient outcomes

Anaesth Crit Care Pain Med. 2022 Oct;41(5):101116. doi: 10.1016/j.accpm.2022.101116. Epub 2022 Jun 25.

Authors

Julien Pico¹, Chrystelle Sola², Anne Charlotte Saour³, Kevin Chapron³, Lucie Coruble³, Sophie Bringuier⁴, Christophe Dadure²

Affiliations

¹ Department of Anaesthesia and Critical Care Medicine, Paediatric Anaesthesia Unit, Montpellier University Hospital, Montpellier, France; Institute of Functional Genomics (IGF), University of Montpellier, CNRS, INSERM, Montpellier, France. Electronic address: j-pico@chu-montpellier.fr.
² Department of Anaesthesia and Critical Care Medicine, Paediatric Anaesthesia Unit, Montpellier University Hospital, Montpellier, France; Institute of Functional Genomics (IGF), University of Montpellier, CNRS, INSERM, Montpellier, France.
³ Department of Anaesthesia and Critical Care Medicine, Paediatric Anaesthesia Unit, Montpellier University Hospital, Montpellier, France.
⁴ Biostatistics and Clinical Research Consultant, Department of Anaesthesiology and Critical Care Medicine, Montpellier University Hospital, Montpellier, France.

PMID: 35764223
DOI: 10.1016/j.accpm.2022.101116

Abstract

Introduction: Adolescent idiopathic scoliosis (AIS) surgeries are major paediatric procedures requiring multidisciplinary management. Enhanced recovery after surgery (ERAS) programs, with proven benefits in adults, remain poorly developed in paediatrics. The main objective of this Before/After study was to evaluate the impact of an ERAS program implementation for AIS on length of stay (LOS) and postoperative recovery.

Methods: The ERAS protocol included intrathecal morphine, standardised multimodal analgesia and multidisciplinary measures for early recovery. Retrospective data from adolescents operated between 2015 and 2017 ("Before ERAS" group) were compared with data from patients benefiting from the ERAS program ("After ERAS" group). Patients treated for neuromuscular scoliosis were not included. After a descriptive analysis, a propensity score matching defined two comparable populations. The main outcome was the LOS. The time to first solid food intake, first ambulation, first bowel movement and Foley removal were also analysed.

Results: During the "Before ERAS" period, 73 underwent PSF for AIS. Thereafter, 65 patients benefited from the ERAS protocol, including 35 for AIS. After propensity score application, 32 patients of the "After ERAS" group were matched with 32 patients of the "Before ERAS" group. The ERAS implementation was associated with 25% reduction in LOS (2.10 ± 1.60 days p < 0.001). All other enhanced recovery criteria were significantly reduced after ERAS implementation.

Conclusion: These results confirm the expected benefits of ERAS program in AIS with a significant impact on postoperative recovery and LOS. Patient adherence and the involvement of all caregivers are essential to the success of such a program.

Keywords: Adolescent idiopathic scoliosis; Enhanced recovery after surgery; Multimodal analgesia; Paediatric anaesthesia; Posterior spinal fusion.

MeSH terms

Adolescent
Adult
Child
Enhanced Recovery After Surgery*
Humans
Length of Stay
Postoperative Complications / epidemiology
Retrospective Studies
Scoliosis* / surgery
Spinal Fusion* / methods