Short term outcomes of an enhanced recovery after surgery (ERAS) pathway versus a traditional discharge pathway after posterior spinal fusion for adolescent idiopathic scoliosis

Fletcher, Nicholas D.; Murphy, Joshua; Austin, Thomas M.; Bruce, Robert W.; Harris, Hilary; Bush, Patricia; Yu, Austin; Kusumoto, Hirofumi; Schmitz, Michael L.; Devito, Dennis P.; Fabregas, Jorge; Miyanji, Firoz

doi:10.1007/s43390-020-00282-3

Cited by 30 publications

(28 citation statements)

References 20 publications

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“…Two published reports were published in 2021, both reporting exclusively on ERAS implementation in spine deformity surgery. Fletcher et al published their short-term outcomes after ERAS for spine deformity [27]. eir data-collected prospectively-showed significantly surgical time, blood loss, and length of stay, while pain control was unchanged.…”

Section: Discussionmentioning

confidence: 99%

Enhanced Recovery Pathway in Adults Undergoing Elective Posterior Thoracolumbar Fusion Surgery: Outcomes Compared with a Traditional Care Pathway

Alsaleh

Murrad

Alzakri

et al. 2021

Advances in Orthopedics

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Introduction. Spine fusion surgery is an increasingly popular procedure, but the patient experience is variable and the cost is high. Enhanced recovery after surgery (ERAS) pathways can provide a standardized plan for spine fusion cases, improving quality of care and reducing costs. We report an early attempt at the implementation of such a pathway and compare it to a historical cohort. Methods. All adult patients undergoing elective posterior thoracolumbar spine fusion in 2019 and 2020 were included in the study. The ERAS protocol implementation started in January 2020. The study cohort was all cases performed in 2020—after implementation of ERAS—while the historical cohort was cases from 2019. Demographic and clinical data were collected and compared between the groups. Results. Ninety-three patients were included in the study. The study cohort (ERAS) included 42 patients, while the comparison group (pre-ERAS) included 51 patients. Demographic and preoperative clinical data were similar between the two groups. However, postoperative clinical data showed that ERAS resulted in less reliance on analgesics, earlier mobilization, and a reduced length of stay. Complication and readmission rates were unchanged. Conclusion. ERAS can reduce costs while maintaining or improving clinical outcomes for spinal fusion surgery.

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Section: Discussionmentioning

confidence: 99%

Enhanced Recovery Pathway in Adults Undergoing Elective Posterior Thoracolumbar Fusion Surgery: Outcomes Compared with a Traditional Care Pathway

Alsaleh

Murrad

Alzakri

et al. 2021

Advances in Orthopedics

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“…2) на момент проведения хирургического лечения составил 14,0 лет (от 7,2 до 16,1). ERAS-протокол применяли в лечении детей с подростковым идиопатическим сколиозом [16][17][18][19][20][21][22][23][24][25], а также с нервно-мышечным сколиозом [26] и детским церебральным параличом [26,27]. Выбранной хирургической тактикой лечения стала дорсальная селективная ризотомия [27] в одном исследовании, а во всех остальных -коррекция деформации позвоночника, спондилодез и транспедикулярная фиксация.…”

Section: результатыunclassified

“…3). ERAS-программа была реализована в большинстве случаев в детских клиниках США [17][18][19][20][21][23][24][25][26][27], а также Франции [22] и Канады [16,19].…”

Section: результатыunclassified

“…В структуре осложнений для ERAS-групп были менее характерны легочные [26] и желудочно-кишечные осложнения [22,24]. В отношении раневой инфекции половина авторов получила сопоставимый уровень осложнений в сравниваемых группах [16,18,19,24,25], а также меньший в группе ERAS [22].…”

Section: в л и я н и е п р и м е н е н и я E R a S на осложненияunclassified

“…-снижения объема кровопотери на 230 мл -от 75 мл [18] до 427 мл [17], в том числе статистически значимо [17]; -снижения времени операции на 83 мин -от 23 мин [25] до 144 мин [19];…”

Section: в л и я н и е п р и м е н е н и я E R a S на осложненияunclassified

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Enhanced recovery after surgery in pediatric spine surgery: systematic review

et al. 2021

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Objective. To conduct a systematic review of the literature on the use of enhanced recovery after surgery (ERAS) protocols in spinalsurgery of children and adolescents to determine the existing evidence of the effectiveness of ERAS implementation in clinical practice.Material and Methods. The authors conducted a systematic review of the literature on ERAS in spinal and spinal cord surgery in children and adolescents selected in the databases of medical literature and search resources of PUBMED/MEDLINE, Google Scholar, Cochrane Library and eLibrary according to the PRISMA guidelines and the PICOS inclusion and exclusion criteria.Results. A total of 12 publications containing information on the treatment of 2,145 children, whose average age was 14.0 years (from 7.2 to 16.1), were analyzed. In the reviewed publications, the average number of key elements of the ERAS program was 9 (from 2 to 20), and a total of 23 elements used in spinal surgery in children and adolescents were identified. The most commonly used elements were preoperative education and counseling, prevention of infectious complications and intestinal obstruction, multimodal analgesia, refusal of routine use of drains, nasogastric probes and urinary catheters, standardized anesthesia protocol, early mobilization and enteral loading. The introduction of the ERAS protocol into clinical practice allowed to reduce the complication rate in comparison with the control group by 8.2 %(from 2 to 19 %), the volume of blood loss by 230 ml (from 75 to 427 ml), the operation time by 83 minutes (from 23 to 144 minutes), theduration of hospitalization by 1.5 days (from 0.5 to 3 days) and the total cost of treatment by 2258.5 dollars (from 860 to 5280 dollars).The ERAS program was implemented in pediatric clinics in the USA (75 %), France (8 %) and Canada (17 %).Conclusion. The conducted systematic review of the literature allows us to conclude that the technology of enhanced recovery after surgery is a promising technology that improves surgical outcomes and is applicable in pediatric practice. There is a significant shortage of published studies evaluating the implementation of ERAS in pediatric surgical practice in general, and in spinal surgery in particular, which requires further prospective randomized studies to evaluate ERAS in spinal surgery in children and adolescents.

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Comparison of interventions and outcomes of enhanced recovery after surgery: a systematic review and meta-analysis of 2456 adolescent idiopathic scoliosis cases

et al. 2021

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Short term outcomes of an enhanced recovery after surgery (ERAS) pathway versus a traditional discharge pathway after posterior spinal fusion for adolescent idiopathic scoliosis

Cited by 30 publications

References 20 publications

Enhanced Recovery Pathway in Adults Undergoing Elective Posterior Thoracolumbar Fusion Surgery: Outcomes Compared with a Traditional Care Pathway

Enhanced Recovery Pathway in Adults Undergoing Elective Posterior Thoracolumbar Fusion Surgery: Outcomes Compared with a Traditional Care Pathway

Enhanced recovery after surgery in pediatric spine surgery: systematic review

Comparison of interventions and outcomes of enhanced recovery after surgery: a systematic review and meta-analysis of 2456 adolescent idiopathic scoliosis cases

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