Enhancing Recovery in Severe Adolescent Idiopathic Scoliosis (AIS) Patients With Cobb Angle ≥90 Degrees Undergoing Single-staged Posterior Spinal Fusion (PSF): Evaluating the Feasibility of Rapid Recovery Protocol (RRP).

STUDY DESIGN

Retrospective study.

OBJECTIVE

To assess the feasibility and outcome of rapid recovery protocol (RRP) in severe adolescent idiopathic scoliosis (AIS) patients with Cobb angle ≥90 degrees underwent single-staged posterior spinal fusion (PSF).

SUMMARY OF BACKGROUND DATA

Corrective surgeries in severe AIS patients entail a higher risk of prolonged operation, excessive bleeding, extended hospital stay, and higher complication rates compared with non-severe AIS patients. Implementation of RRP among severe AIS patients has not been reported.

METHODS

Thirty-seven severe AIS patients who underwent single-staged PSF surgery from 2019 to 2022 were recruited. The RRP consisted of a preoperative regime and counselling, intraoperative strategies to reduce operation duration and blood loss and an accelerated postoperative rehabilitation pathway. Outcome measures were operative time, blood loss, postoperative pain scores, patient-controlled analgesia (PCA) morphine usage, length of hospital stay, and recovery milestones. Descriptive statistics were reported in mean (SD) for numerical data, whereas categorical data were presented in n (%).

RESULTS

The mean operation duration was 173.5±39.4 minutes, and the mean blood loss was 1064.6±473.3 mL. The average postoperative hospital stay was 3.2±0.6 days. Twelve hours post-operation pain score was 4.0±2.0 and reduced to 3.9±1.6 at 48 hours. 78.4% of patients discontinued their PCA at 48 hours. First liquid intake was at 6.3±8.5 hours, whereas solid food consumption was initiated at 23.4±14.2 hours. The urinary catheter was removed at 17.8±7.6 hours. Patients started ambulation at 24±12.7 hours, first passed flatus at 37.7±20.4 hours and had their first bowel movement at 122.1±41.7 hours. Three complications (8.1%) were reported, which included superficial surgical site infection, proximal wound stitch abscess and superficial thermal injury due to forced air-warming blanket.

CONCLUSION

The implementation of the RRP after PSF in severe AIS patients was feasible and resulted in a short postoperative hospital stay of 3.2 days without increasing the risk of major complications, readmissions, and reoperations.