Physiotherapy Department, The Royal Children's Hospital, Melbourne, VIC, Australia.
Department of Anaesthesia and Pain Management Service, The Royal Children's Hospital, Melbourne, VIC, Australia.
Spine Deform. 2021 Sep;9(5):1371-1377. doi: 10.1007/s43390-021-00340-4. Epub 2021 Apr 6.
Traditionally, spinal surgery for Adolescent Idiopathic Scoliosis (AIS) has seen long hospital length of stay (LOS) and slow mobility progression. Postoperative enhanced recovery pathways (ERP) for this population in North America and Asia have successfully reduced LOS and hospital costs without increasing complications. This study assessed if ERP introduced in an Australian center achieves similar results.
A pre-post intervention study compared a historical AIS cohort having a posterior spinal fusion (PSF) who received conventional care (CC) (2013-2014) with prospectively assessed ERP recipients (2016-2018) separated by 1-year implementation period. Patient characteristics, surgical details, postoperative analgesia, mobilization, LOS and complication outcomes were collected.
The 32 CC and 61 ERP recipients had similar demographics. ERP recipients had 44% decreased LOS (mean LOS 3.5 ± 0.9 days vs. CC 6.3 ± 0.9 days, p < 0.001) as all ERP milestones were achieved sooner including transition to oral analgesia (MD - 2 days, 95% CI 1.8-2.3), oral intake (MD - 2.3 days, 95% CI 2.0-2.6) and mobilization, with fewer physiotherapy sessions (5.2 vs 8, p < 0.001). Postoperative in-hospital costs were 50.2% less for ERP vs CC (AUD $8234 vs $16,545). Due to small sample size, no differences between the groups were detectable for complications (4.9% vs 6.3%) or readmission (1.6% vs 3.1%).
An ERP for AIS after PSF in this Australian center improved functional recovery reducing LOS and by associated postoperative inpatient costs. Other Australian hospitals should consider an ERP for this population with larger-scale audit to assess impact upon complications.
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传统上，青少年特发性脊柱侧凸（AIS）的脊柱手术需要长时间住院（LOS）和缓慢的活动进展。北美和亚洲针对该人群的术后加速康复途径（ERP）成功减少了 LOS 和住院费用，而没有增加并发症。本研究评估了在澳大利亚中心引入 ERP 是否会产生类似的结果。
一项前后干预研究比较了接受传统治疗（CC）的后路脊柱融合术（PSF）的 AIS 历史队列（2013-2014 年）和前瞻性评估的 ERP 接受者（2016-2018 年），实施期为 1 年。收集了患者特征、手术细节、术后镇痛、活动、 LOS 和并发症结果。
32 例 CC 和 61 例 ERP 接受者的人口统计学特征相似。ERP 接受者的 LOS 减少了 44%（平均 LOS 3.5±0.9 天 vs. CC 6.3±0.9 天，p<0.001），因为所有的 ERP 里程碑都更早地实现了，包括过渡到口服镇痛（MD-2 天，95%CI 1.8-2.3）、口服摄入（MD-2.3 天，95%CI 2.0-2.6）和活动，同时减少了物理治疗次数（5.2 次 vs. 8 次，p<0.001）。ERP 比 CC 的术后住院费用低 50.2%（AUD 8234 澳元 vs. 16545 澳元）。由于样本量小，两组在并发症（4.9% vs. 6.3%）或再入院（1.6% vs. 3.1%）方面无差异。
本澳大利亚中心 PSF 后 AIS 的 ERP 改善了功能恢复，缩短了 LOS，并降低了术后住院费用。其他澳大利亚医院应考虑为该人群实施 ERP，并进行更大规模的审计，以评估对并发症的影响。
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