Abstract
Study designA systematic review reporting on the efficacy of an ERAS protocol in patients undergoing spinal fusion for AIS.ObjectiveTo 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 dataERAS 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.MethodsA 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.ResultsOf 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.ConclusionThis 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 evidence3.
Highlights
Corrective surgery for Adolescent Idiopathic Scoliosis (AIS), involves many perioperative challenges including patient and family counseling, optimization of the patient, adequate pain control, effective management of side-effects due to opioids, and early mobilization amongst others [1]
A literature search was performed using PUBMED and MEDLINE databases for articles published between December 1999 to May 2020 using “adolescent idiopathic scoliosis”, “idiopathic scoliosis”, “scoliosis”, “deformity correction”, “posterior spinal fusion”, “accelerated recovery protocol”, “discharge protocol”, “pain management”, “postoperative recovery”, “accelerated discharge”, “hospital stay” and “complications” as keywords in combination with Boolean “AND” and “OR” phrases
Chan et al did not provide the average age for the traditional protocols (TPs) group and again was excluded
Summary
Corrective surgery for Adolescent Idiopathic Scoliosis (AIS), involves many perioperative challenges including patient and family counseling, optimization of the patient, adequate pain control, effective management of side-effects due to opioids, and early mobilization amongst others [1]. If these are not appropriately addressed, they may result in a delayed return to function, prolonged hospital stay, and increased costs. A recent systematic review reported a reduction in the length of stay without an increase in complications or readmission rates following the use of ERAS-based protocols after elective spine surgery [3]. This study, was not specific to patients undergoing posterior scoliosis correction
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