Application of enhanced recovery after surgery in the perioperative management of pediatric patients with congenital scoliosis

English Keywords:Enhanced recovery after surgery  Spinal deformity  Surgery  Stress reaction  Children

English Abstract:

  【Abstract】 Objectives: To explore the application effects of enhanced recovery after surgery(ERAS) in the perioperative management of children with congenital scoliosis(CS). Methods: 90 pediatric patients with CS treated in our hospital with posterior osteotomy and bone graft fusion combined with internal fixation from October 2020 to December 2021 were included in this study. The patients were divided into the ERAS group(n=45) and control group(n=45) according to the periorperative management model. Patients in the ERAS group were managed with an accelerated recovery protocol including preoperative education, high protein diet, shortened fasting time, optimized anesthesia, non-excessive fluid infusion, decreased drainage placement, and multi-model analgesia, while patients in the control group were managed with the traditional model during perioperative period. Clinical data comprising perioperative fasting time, postoperative length of hospital stay, complication rate, and amount of oral intake, pain score and body temperature within postoperative 3d, and laboratory tests included hemoglobin(Hb), albumin(ALB) and interleukin-6(IL-6) on postoperative 1d and 3d were collected and compared between groups. Results: All the patients completed the surgery successfully. In the first 3 days after surgery, the pain score of the ERAS group was significantly lower than that of control group(P<0.001), and the diet of patients of ERAS group recovered faster with a significantly greater amount of daily intake than that of control group(P<0.001). Within 3d after operation, the maximum body temperature>38.5℃ was observed in 27 and 44 patients in the ERAS and control group, respectively, and the ERAS group was significantly smaller in the number than control group( χ2=7.211, P=0.007). The fasting time were 11.0±5.6h and 30.1±8.1h(t=-13.028, P<0.001) and postoperative length of hospital stay were 6d(6, 7d) and 7d(6, 7d)(Z=-0.2057, P=0.040) in the ERAS and control group, respectively, and the ERAS group was significantly shorter than control group. Postoperative complications were observed in 8(17.8%) and 6(13.3%) patients in the ERAS and control group( χ2=0.338, P=0.561), and the most common complication was mild abdominal pain and distention in both groups. Both Hb and ALB in the two groups showed no significant difference on postoperative day 1 and 3(P>0.05). IL-6 tested on postoperative day 1 was 147.7±116.1mmol/L and 184.5±144mmol/L(t=-1.334, P=0.186) in the ERAS and control group, while the data was 19.4±12.2mmol/L and 33.5±26.3mmol/L(t=-3.252, P=0.002) on postoperative day 3, and the ERAS group was significantly lower than the control group. Conclusions: Comparing with traditional model, ERAS can improve the perioperative management level, promote the early recovery, and decrease the postoperative stress reaction for pediatric patients with congenital spinal scoliosis.