Design and implementation of an enhanced recovery after surgery(ERAS) pathway for adolescent idiopathic scoliosis surgery perioperative management

English Keywords:Enhanced recovery after surgery  Adolescent idiopathic scoliosis  Perioperative management  Scoliosis correction surgery

English Abstract:

  【Abstract】 Objectives: To evaluate the effect of enhanced recovery after surgery(ERAS) on perioperative management in patients with adolescent idiopathic scoliosis. Methods: Ninety-one adolescent idiopathic scoliosis patients who received correction surgery without 3-column osteotomy were retrospectively analyzed from September 2010 to August 2016 in our hospital. Of these patients, 51 cases were treated by traditional programs(control group) and 40 cases were treated with ERAS programs (ERAS group). The following data of the two groups were collected and analyzed: age, gender, body mass index(BMI), preoperative hemoglobin, ASA grade, curve type(Lenke classification), Cobb angle, operating time, fusion levels, the number of pedicle screws placed, coronal correct rate, estimated blood loss, allogenic blood transfusion rate, postoperative hemoglobin, postoperative visual analogue scale(VAS) score, hemovac drainage, extubation time, postoperative length of hospital stay(LOS), satisfactory rate, postoperative complications. An independent samples t test was used to compare continuous variables between control group and ERAS group. A chi-square test, or Fisher′s exact test if more appropriate, was used to compare categorical variables between control group and ERAS group. Results: There was no significant difference in preoperative data between the two groups. Intraoperative blood loss in ERAS group was 515.0±14.9ml, which was significantly lower than that in control group 865.7±309.8ml(t=5.830, P＜0.001). Allogenic blood transfusion rate in ERAS group was 25.0% (10/40), which was significantly lower than that in control group of [64.7%(33/51)] (χ2=14.1, P＜0.001). The postoperative hemoglobin of ERAS group was 108.3±14.8g/L, which was significantly higher than that in control group of 100.0±14.9g/L(t=2.629, P=0.010). The postoperative VAS scores 48 hours after surgery in ERAS group was significantly lower than that in control group(P=0.035). The hemovac drainage in ERAS was 30.0±25.6ml, which was significantly lower than that in control group of 662.4±294.4ml (t=13.532, P＜0.001). The extubation time of ERAS group was 22.7±10.6h, which was significantly lower than that of control group of 58.7±13.3h (t=13.942, P＜0.001). Postoperative LOS of ERAS group was 6.5±2.1d, which was significantly lower than that in control group of 7.6±1.6d(t=2.843, P=0.006) The satisfaction rate of ERAS group was 92.5%(37/40), which was significantly higher than that in control group of 74.5%(38/51) (χ2=4.302, P=0.038). The rate of PONV in ERAS group was 10.0%(4/40), which was significantly lower than that in control group of 27.5%(14/51)(χ2=4.302, P=0.038). Conclusions: ERAS is capable of improving the perioperative status of AIS patients, with earlier rehabilitation and better satisfaction.