P135. Does a dedicated scoliosis team and surgical standardization improve outcomes in adolescent idiopathic scoliosis surgery and is it reproducible?

Abstract

<h3>BACKGROUND CONTEXT</h3> Expedited recovery after surgery protocols and the perioperative surgical home are two initiatives that address the need for increased efficiency in patient care. In 2011, we implemented a standardized approach including a "scoliosis team" of dedicated anesthesiologists, operating room nurses, surgical technicians, and neurophysiologists. We also implemented a standardized preoperative work-up, specific intraoperative protocols including the use of anti-fibrinolytics and intrathecal morphine, and a multidisciplinary postoperative care model. <h3>PURPOSE</h3> The purpose of this study is to determine if standardization improves AIS surgery outcomes and whether it is transferrable between institutions. <h3>STUDY DESIGN/SETTING</h3> Retrospective multicenter review. <h3>PATIENT SAMPLE</h3> Adolescent Idiopathic Scoliosis patients that underwent surgery between 2009 and 2018. <h3>OUTCOME MEASURES</h3> Surgical outcomes including operative time and length of stay. <h3>METHODS</h3> In each institution, a non-standardized group (NST) and a standardized group (ST), were compared. Demographics and perioperative outcomes were recorded. In 2015, the surgeons changed institutions (to IB). Reproducibility was determined between institutions (IA vs IB). Median (IQR), Kruskal-Wallis, and Fisher's exact test were used. <h3>RESULTS</h3> A total of 325 AIS patients were collected from the database. The non-standardized group (NST) included 44 patients, while the standardized group (ST) included 281 patients. Age (p=0.21), BMI (p=0.48), preoperative Cobb angle (p=0.48), levels fused (p=0.42), and correction percentage (p=0.39) were all similar. Standardized protocol patients had lower estimated blood loss (EBL) (700 ml vs 325 ml, p<0.001), shorter anesthesia time (437 min vs 384 min, p=0.004), shorter surgical time (310 min vs 248 min, p<0.001), and shorter length of stay (LOS) (7 days vs 5 days, p<0.001). IA (n=101) and IB (n=105) were compared. Age (p=0.21), BMI (p=0.48) and preoperative Cobb angle (p=0.48) were similar. EBL (p<0.001), anesthesia time (p<0.001), surgical time (p<0.001), and LOS (p<0.001) were significantly lower in IB. <h3>CONCLUSIONS</h3> A standardized AIS approach including a dedicated operative team, preoperative work up, postoperative multidisciplinary management, and streamlined surgical steps improves outcomes and efficiency. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.