High Satisfaction in Adolescent Idiopathic Scoliosis Patients on Enhanced Discharge Pathway

Abstract

Background: Recently, there have been several reports of using an enhanced discharge pathway following posterior spinal fusion (PSF) in patients with adolescent idiopathic scoliosis (AIS). No previous studies have prospectively examined patient satisfaction of patients with AIS using an enhanced discharge pathway. The purpose of this study was to evaluate patient satisfaction with an enhanced discharge pathway for PSF and whether patients felt that their length of stay was appropriate. Methods: Patients with AIS undergoing PSF were prospectively enrolled. At their first postoperative clinic visit, patients were administered a survey regarding their experience. Results: Of the 46 patients enrolled (mean age, 14 y), 1 was discharged on postoperative day (POD) 2, 33 were discharged on POD 3, 9 were discharged on POD 4, and 3 were discharged on POD 5. Eighty (37/46) of patients felt that they were discharged at an appropriate time, whereas 20% (9/46) felt they were discharged too early. Patients who felt they were discharged at an appropriate time (mean, 3.2 d) had a trend toward shorter stays than those who felt they were discharged too early (mean, 3.7 d). Overall patient satisfaction of hospital stay was high with a mean of 9 on a 10-point scale (range, 1 to 10). There was no correlation between length of stay and patient satisfaction (P=0.723). Patients who felt they were discharged early had a significantly higher mean FACES pain scores than those who felt they were discharged about right both as inpatients (mean, 4.8 vs. 3.4; P=0.0319) and at their first postoperative clinic visit (5.4 vs. 2.9; P=0.004). Conclusions: Eighty percent of patients with AIS who underwent PSF felt that the time of discharge was appropriate with an enhanced discharge pathway. There was no correlation between patient satisfaction and length of stay. Level of Evidence: Level II.

Fast-track protocols for patients undergoing spine surgery: a systematic review

“…In our quality assessment for spine surgery the 44% [ 15 , 23 , 27 , 29 , 32 – 38 , 40 – 42 , 46 – 49 , 51 , 55 , 56 , 61 , 67 , 68 , 70 ] of the studies were rated strong, 25% [ 17 , 18 , 21 , 22 , 25 , 28 , 31 , 39 , 43 , 44 , 60 , 62 , 63 , 65 ] were rated moderate, and 32% [ 16 , 19 , 20 , 24 , 26 , 30 , 45 , 50 , 52 – 54 , 57 – 59 , 64 , 66 , 69 , 71 ] were rated weak. Methodological weaknesses that led to moderate or weak quality scores often included the lack of a sample size justification, power description, or variance and effect estimates, the lack of subjects selected or recruited from the same population, the lack of results evaluation more than once over in time, the lack of blinded assessor and the lack of measurement of potential confounding variables.…”

“…↓ODI score (from 40 ± 13 to 17 ± 11) Wang et al 2020 [ 59 ] Retrospective 190 patients: -Fast-track group ( n = 95, 72.39 ± 6.12 age, 52.6% females); −Non-fast-track, ( n = 95, mean age 70.81 ± 6.27, 57.8% females) Yes Lumbar fusion surgery for lumbar disk herniation or spinal stenosis 1 or 2 Hypertension, heart disease, diabetes, osteoporosis, gastrointestinal, psychological symptoms NR 12.30 ± 3.03 1 spinal fluid leakage, 1 neurological 1 30 days readmission 30 days ↓LOS (12.30 ± 3.03 vs. 15.50 ± 1.88) in fast-track group vs. non-fast-track group. =operative time, levels fused, EBL, pain score, complication, mortality, 30 days readmission Yang et al 2020 [ 60 ] Prospective Fast-track group: 46 patients (mean age 14.3, 89.1% female) No PSF (with local autograft and allograft bone graft) for AIS < or > L2 NR NR 3.3 days 5% constipation NR 15 days LOS = 3.3 days: 1 patient discharge at day 2, 33 at day 3, 9 at day 4, 3 at day 5. Satisfaction on discharge at appropriate time = 80%, at discharge too early = 20%.…”

“…Anesthesiologic screening, cardiologist, nutritional (BMI > 30 kg/m2) consultations NR NR NR Antimicrobial prophylaxis (broad-spectrum antibiotic), low-molecular-weight heparin General anesthesia (propofol, sufentanil), LIA (2.5 mg/ml ropivacaine intramuscularly prior to incision), muscle relaxants limited Hypothermia prevention (warm-air blankets), fluid imbalance and blood transfusion prevention, vasopressors, autologous cell-salvage NR Venkata et al 2018 [ 57 ] General informations. Physician and anesthesiological consultations NR NR NR NR General anesthesia, LIA (20 ml 0.25% bupvicaine during or after closure), multimodal analgesia (remifentanil hydrochloride, IV paracetamol, COX-2 inhibitor paracoxib sodium, small dose of morphine), antibiotic prophylaxis (1.5 g cefuroxime at induction anesthesia, chlorhexidine skin cleanse of operative site), no drain or catheter No transfusion NR Wang et al 2017 [ 58 ] General informations NR Enteral nutrition (protein uptake) NR Fasting (8 h for liquids, 12 h for solids), carbohydrate loading, antimicrobial prophylaxis and skin preparation (first-generation cephalosporin 1 h before incision, vaccination for MRSA) Anesthesia (short-duration sedation, IV propofol and ketamine, oxygen), local analgesia (long-acting liposomal bupivacaine), osteobiologic adjuvants, no drains, catheter and narcotic medications Normothermia and blood pressure maintain, fluid balance (cardiac output monitoring) NR Wang et al 2020 [ 59 ] General informations NR Fasting, fluid and carbohydrate loading NR Antimicrobial prophylaxis Standard anesthetic protocol, LIA TXA, normothermia maintein NR Yang et al 2020a [ 60 ] General informations NR Diet NR Clear liquid diet (day of surgery), neurontin (30 min before) Intrathecal morphine (at the start of procedure) NR NR Yang et al 2020b [ 61 ] General informations. Nutrition and psychological consultations NR Increased albumin infusion and improved enteral uptake Preemptive analgesia (muscle relaxant, NSAID, celecoxib, meloxicam, flurbiprofen, or ...…”

Local Infiltration Anesthesia with Liposomal Bupivacaine Decreases Postoperative Narcotic Consumption in AIS

“…Over the last 5 years, multiple standardized postoperative care pathways for patients undergoing posterior spinal fusion (PSF) for the treatment of adolescent idiopathic scoliosis (AIS) have been published. [1][2][3][4] A key feature of these AIS care pathways is a multimodal approach to pain control. Several non-opioid analgesic medications, including gabapentinoids, acetaminophen (paracetamol), nonsteroidal anti-inflammatory drugs (NSAIDs), and muscle relaxants (Valium [diazepam]), are given in combination with opioid medications.…”

Application of Out-of-Hospital Extended Nursing in Brace Treatment of Patients with Idiopathic Scoliosis

“…It will not only cause body deformity, back pain, mobility inconvenience, psychological burden and so on, more importantly, affect the heart and lung functions of patients [3][4] . Therefore, early conservative treatment is of great significance to the disease [5][6][7][8][9][10] . However, the poor compliance behaviors of teenagers after discharge seriously affects the therapeutic effect [11] , in order to study the rehabilitation training of patients after discharge and the compliance with the correct brace wear, and to further improve the compliance behaviors of patients after discharge, we implemented outof-hospital extended nursing for patients with idiopathic : 92-95 (1) Patients meet the diagnostic criteria for adolescent idiopathic scoliosis [12] .…”