Enhanced recovery following posterior spinal fusion for adolescent idiopathic scoliosis: A medical and economic study in a French private nonprofit pediatric hospital - 30/09/23
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Highlights |
• | Medico-economic comparative observational study between two groups of posterior vertebral fusion for adolescent idiopathic scoliosis: a prospective group with ERAS in 2020–2021 (n=30) and a retrospective group with standard care in 2017–2018 (n=30). |
• | The preoperative and peroperative data were comparable between groups (p>0.5). |
• | The hospital fees were reduced on average by 3029 euros per patient. The average LOS was 5 days in the ERAS group versus 6.5 days in the control group (p<0.001). |
• | VAS pain on D1 and D3 was lower in the ERAS group. One postoperative complication was noted per group. |
Abstract |
Introduction |
Little data exist on the efficacy of enhanced recovery after surgery (ERAS) protocols in patients undergoing posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS).
Hypothesis |
ERAS reduces hospital costs (HC) and length of stay (LOS) without increasing pain or complications.
Materials and methods |
This was a retrospective comparative medical and economic study of 2 cohorts of patients who underwent PSF for AIS: a prospective group who underwent surgery with an ERAS protocol without a specially assigned care coordinator from 2020 to 2021 (n=30) and a retrospective group (control) who received standard care from 2017 to 2018 (n=30). The key amendments to the ERAS protocol were reduced preoperative investigations, opioid-sparing analgesia, ambulation starting on postoperative day (POD) 1, early resumption of oral diet, and early transition to oral analgesics. Moreover, an intensive care unit (ICU) stay, surgical drainage, and the postoperative CT scan were no longer routine. The discharge criteria were the same for both groups: normal bowel function, independent walking, pain Visual Analog Scale (VAS)<3 without strong opioids, and no signs of complications. The endpoints were: decreased HC (calculated by subtracting the costs of hospital days and complementary exams that were not carried out) and LOS, complications, and postoperative pain according to the VAS on POD 1, POD 3, and discharge. All means were reported with the standard deviation.
Results |
The mean age of patients undergoing surgery (14.5±1.7 years), sex ratio, curve type according to the Lenke classification, mean Cobb angle (54±12°), and the number of instrumented vertebrae (9±2) were similar in both groups (p>0.5).
The HC decreased on average by 3029€ per patient. The mean LOS was 5±0.9 days in the ERAS group versus 6.5±0.6 days in the control group (p<0.001). The VAS scores on POD 1 and POD 3 were lower in the ERAS group. One postoperative complication was noted in each group.
Conclusion |
Implementing an ERAS protocol without a specifically assigned care coordinator for patients with AIS undergoing PSF significantly decreased HC, LOS, and early postoperative pain.
Level of evidence |
III; retrospective comparative study.
Le texte complet de cet article est disponible en PDF.Keywords : ERAS, Adolescent idiopathic scoliosis, Costs, Length of stay, Intensive care
Abbreviations : ERAS, LOS, HC, AIS, PSF, IRB, POD, VAS, ICU
Plan
Vol 109 - N° 6
Article 103626- octobre 2023 Retour au numéro
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