Spine Unit, Department of Orthopaedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
J Pediatr Orthop. 2023 Jul 1;43(6):e476-e480. doi: 10.1097/BPO.0000000000002400. Epub 2023 Mar 16.
Enhanced recovery after surgery (ERAS) protocols are often specific to a specific type of surgery without assessing the overall effect on the ward. Previous studies have demonstrated reduced length of stay (LOS) with ERAS protocols in patients with adolescent idiopathic scoliosis (AIS), although the patients are often healthy and with few or no comorbidities. In 2018, we used ERAS principles for patients undergoing AIS surgery with a subsequent 40% reduced LOS. The current study aims to assess the potential collateral effect of LOS in patients surgically treated for neuromuscular scoliosis admitted to the same ward and treated by the same staff but without a standardized ERAS protocol.
All patients undergoing neuromuscular surgery 2 years before and after ERAS introduction (AIS patients) with a gross motor function classification score of 4 to 5 were included. LOS, intensive care stay, and postoperative complications were recorded. After discharge, all complications leading to readmission and mortality were noted with a minimum of 2 years of follow-up using a nationwide registry.
Forty-six patients were included; 20 pre-ERAS and 26 post-ERAS. Cross groups, there were no differences in diagnosis, preoperative curve size, pulmonary or cardiac comorbidities, weight, sex, or age. Postoperative care in the intensive care unit was unchanged between the two groups (1.2 vs 1.1; P = 0.298). When comparing LOS, we found a 41% reduction in the post-ERAS group (11 vs 6.5; P < 0.001) whereas the 90-day readmission rates were without any significant difference (45% vs 34% P = 0.22) We found no difference in the 2-year mortality in either group.
The employment of ERAS principles in a relatively uncomplicated patient group had a positive, collateral effect on more complex patients treated in the same ward. We believe that training involving the caregiving staff is equally important as pharmacological protocols.
手术快速康复（ERAS）方案通常针对特定类型的手术，而不评估其对病房的整体影响。先前的研究表明，ERAS 方案可降低青少年特发性脊柱侧凸（AIS）患者的住院时间（LOS），尽管这些患者通常健康，合并症少或没有。2018 年，我们在接受 AIS 手术的患者中使用了 ERAS 原则，随后 LOS 减少了 40%。本研究旨在评估在同一病房接受神经肌肉性脊柱侧凸手术且由同一医护团队治疗但未采用标准化 ERAS 方案的患者中 LOS 的潜在附带影响。
所有在 ERAS 引入前 2 年和后 2 年接受神经肌肉手术且格拉斯哥-马里博尔运动功能分级为 4-5 分的患者均被纳入研究。记录 LOS、重症监护停留时间和术后并发症。出院后，使用全国性登记系统，对导致再入院和死亡的所有并发症进行至少 2 年的随访。
共纳入 46 例患者；20 例为 ERAS 前组，26 例为 ERAS 后组。两组患者在诊断、术前脊柱侧凸大小、肺部或心脏合并症、体重、性别或年龄方面无差异。两组患者在重症监护室的术后护理无差异（1.2 比 1.1；P = 0.298）。比较 LOS 时，我们发现 ERAS 后组的 LOS 降低了 41%（11 比 6.5；P < 0.001），而 90 天再入院率无显著差异（45%比 34%；P = 0.22）。两组患者的 2 年死亡率无差异。
在相对简单的患者群体中采用 ERAS 原则对在同一病房接受治疗的更复杂患者产生了积极的附带影响。我们认为，涉及医护人员的培训与药物治疗方案同样重要。
