Enhanced Recovery After Surgical Correction of Adolescent Idiopathic Scoliosis

Background: Few publications in the literature examine enhanced recovery after scoliosis surgery (ERAS) in children, despite significant scientific interest in adults. The objective of the current study was to describe an ERAS protocol for surgical correction of adolescent idiopathic scoliosis (AIS) and its results.

Methods: ERAS outcomes were measured in two patient cohorts. Historical controls and ERAS groups were selected from patients managed for scoliosis surgery in 2015 and 2018, respectively. The ERAS protocol included fasting minimization, carbohydrate loading, the avoidance of background morphine infusions, perioperative opioid-sparing protocols, the use of a cooling brace, early physiotherapy, feeding and oral medications, and the early removal of urinary catheters and surgical drains. The main outcome of the study was hospital length of stay.

Results: Overall, 82 controls and 81 ERAS patients were recruited. ERAS protocols were observed in over 80% of patients for almost items. Median length of hospital stay was significantly lower in the ERAS group, (- 3 [95% confidence interval: -2; -4] days). Median morphine consumption was reduced by 25% and 35% on day 2 and 3, respectively. The incidence of PONV did not differ between the two groups and the incidence of constipation decreased slightly but significantly in the ERAS group on day 2. Pain intensity at rest and movement were lower in the ERAS group at day 2 and 3.

Conclusions: The current study suggests an ERAS protocol post adolescent idiopathic scoliosis surgery is associated reduced hospital length of stay and improved postoperative care.

Keywords: Enhanced recovery after surgery; children; opioids; scoliosis.