Adoption of an Enhanced Recovery After Surgery Protocol for Neuromuscular Scoliosis Shortens Length of Hospital Stay

Overview

Journal Spine Surg Relat Res

Date 2024 Aug 12

PMID 39131418

Authors

Naoyuki Nakamura

Yuichiro Kawabe

Takako Momose

Masatoshi Oba

Kouji Yamamoto

Tetsuya Takamasu

Mayuko Suzuki

Nobuto Nakamura

Miki Koba

Affiliations

Soon will be listed here.

Abstract

Introduction: We aimed to implement the enhanced recovery after surgery (ERAS) protocol for pediatric neuromuscular scoliosis (NMS) surgery and to examine the effectiveness of this program in this study.

Methods: Subjects were children with NMS who underwent scoliosis surgery at our department by a surgeon using a single posterior approach. A series of 27 cases before the introduction of ERAS and 27 cases during program stabilization were included in the study. Patient backgrounds did not show significant differences before and after introducing ERAS. Perioperative data, complications, length of hospital stay (LOS), and readmission within 90 days were investigated and statistically analyzed.

Results: When the pre- and post-ERAS induction groups were compared, no significant differences in anesthesia induction time (p=0.979), pelvic fixation (p=0.586), fusion levels (p=0.479), intraoperative hypothermia duration (p=0.154), end-of-surgery body temperature (p=0.197), operative time (p=0.18), postoperative main Cobb angle (p=0.959), main Cobb angle correction rate (p=0.91), postoperative spino-pelvic obliquity (SPO) (p=0.849), and SPO correction rate (p=0.267) were observed. However, significant differences in using V-flap technique (p=0.041), intraoperative blood loss (p=0.001), and LOS (p=0.001) were observed. Intraoperative blood loss was weakly correlated with LOS (p=0.432 and 0.001). No statistically significant difference existed between the V-flap method and LOS (p=0.265). Multiple regression analysis using LOS as the objective variable and ERAS protocols and intraoperative blood loss as explanatory variables revealed that the effect of ERAS on LOS was greater than that of intraoperative blood loss. No statistically significant differences in the readmission rates within 90 days were found.

Conclusions: After the introduction of ERAS, LOS decreased without an increase in complications or readmissions within 90 days.

Citing Articles

A Prospective Study on the Feasibility and Effect of an Optimized Perioperative Care Protocol in Pediatric Neuromuscular Scoliosis Surgery.

Naume M, Hoei-Hansen C, Born A, Brekke G, Hoj A, Nielsen M J Clin Med. 2025; 13(24.

PMID: 39768771 PMC: 11676504. DOI: 10.3390/jcm13247848.

References

Miyanji F, Nasto L, Sponseller P, Shah S, Samdani A, Lonner B . Assessing the Risk-Benefit Ratio of Scoliosis Surgery in Cerebral Palsy: Surgery Is Worth It. J Bone Joint Surg Am. 2018; 100(7):556-563. DOI: 10.2106/JBJS.17.00621. View

Lange N, Stadtmuller T, Scheibel S, Reischer G, Wagner A, Meyer B . Analysis of risk factors for perioperative complications in spine surgery. Sci Rep. 2022; 12(1):14350. PMC: 9399240. DOI: 10.1038/s41598-022-18417-z. View

McKinnon C, Meehan E, Harvey A, Antolovich G, Morgan P . Prevalence and characteristics of pain in children and young adults with cerebral palsy: a systematic review. Dev Med Child Neurol. 2018; 61(3):305-314. DOI: 10.1111/dmcn.14111. View

Sedra F, Shafafy R, Sadek A, Aftab S, Montgomery A, Nadarajah R . Perioperative Optimization of Patients With Neuromuscular Disorders Undergoing Scoliosis Corrective Surgery: A Multidisciplinary Team Approach. Global Spine J. 2020; 11(2):240-248. PMC: 7882827. DOI: 10.1177/2192568220901692. View

Fletcher N, Shourbaji N, Mitchell P, Oswald T, Devito D, Bruce R . Clinical and economic implications of early discharge following posterior spinal fusion for adolescent idiopathic scoliosis. J Child Orthop. 2014; 8(3):257-63. PMC: 4142881. DOI: 10.1007/s11832-014-0587-y. View

Fearon K, Ljungqvist O, von Meyenfeldt M, Revhaug A, Dejong C, Lassen K . Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr. 2005; 24(3):466-77. DOI: 10.1016/j.clnu.2005.02.002. View

Bohtz C, Meyer-Heim A, Min K . Changes in health-related quality of life after spinal fusion and scoliosis correction in patients with cerebral palsy. J Pediatr Orthop. 2011; 31(6):668-73. DOI: 10.1097/BPO.0b013e318221093c. View

Rumalla K, Yarbrough C, Pugely A, Dorward I . Spinal Fusion for Pediatric Spondylolisthesis: National Trends, Complications, and Short-Term Outcomes. Neurosurgery. 2017; 82(5):701-709. DOI: 10.1093/neuros/nyx295. View

Samdani A, Belin E, Bennett J, Miyanji F, Pahys J, Shah S . Major perioperative complications after spine surgery in patients with cerebral palsy: assessment of risk factors. Eur Spine J. 2015; 25(3):795-800. DOI: 10.1007/s00586-015-4054-3. View

10.

Tipper G, Chiwera L, Lucas J . Reducing Surgical Site Infection in Pediatric Scoliosis Surgery: A Multidisciplinary Improvement Program and Prospective 4-Year Audit. Global Spine J. 2020; 10(5):633-639. PMC: 7359689. DOI: 10.1177/2192568219868200. View

11.

Sewell M, Malagelada F, Wallace C, Gibson A, Noordeen H, Tucker S . A Preliminary Study to Assess Whether Spinal Fusion for Scoliosis Improves Carer-assessed Quality of Life for Children With GMFCS Level IV or V Cerebral Palsy. J Pediatr Orthop. 2015; 36(3):299-304. DOI: 10.1097/BPO.0000000000000447. View

12.

Kahokehr A, Sammour T, Zargar-Shoshtari K, Thompson L, Hill A . Implementation of ERAS and how to overcome the barriers. Int J Surg. 2008; 7(1):16-9. DOI: 10.1016/j.ijsu.2008.11.004. View

13.

Lan T, Hu S, Yang X, Chen Y, Qiu Y, Guo W . The efficacy of bipolar sealer on blood loss in spine surgery: a meta-analysis. Eur Spine J. 2017; 26(7):1796-1802. DOI: 10.1007/s00586-017-5045-3. View

14.

Larsson E, Aaro S, Normelli H, Oberg B . Long-term follow-up of functioning after spinal surgery in patients with neuromuscular scoliosis. Spine (Phila Pa 1976). 2005; 30(19):2145-52. DOI: 10.1097/01.brs.0000180403.11757.6a. View

15.

Jones K, Sponseller P, Shindle M, McCarthy M . Longitudinal parental perceptions of spinal fusion for neuromuscular spine deformity in patients with totally involved cerebral palsy. J Pediatr Orthop. 2003; 23(2):143-9. View

16.

Fletcher N, Bellaire L, Dilbone E, Ward L, Bruce Jr R . Variability in length of stay following neuromuscular spinal fusion. Spine Deform. 2020; 8(4):725-732. DOI: 10.1007/s43390-020-00081-w. View

17.

Watanabe K, Lenke L, Daubs M, Watanabe K, Bridwell K, Stobbs G . Is spine deformity surgery in patients with spastic cerebral palsy truly beneficial?: a patient/parent evaluation. Spine (Phila Pa 1976). 2009; 34(20):2222-32. DOI: 10.1097/BRS.0b013e3181948c8f. View

18.

Vivas A, Pahys J, Jain A, Samdani A, Bastrom T, Sponseller P . Early and late hospital readmissions after spine deformity surgery in children with cerebral palsy. Spine Deform. 2020; 8(3):507-516. DOI: 10.1007/s43390-019-00007-1. View

19.

Tondevold N, Johanning Bari T, Andersen T, Gehrchen M . The Collateral Effect of Enhanced Recovery After Surgery Protocols on Spine Patients With Neuromuscular Scoliosis. J Pediatr Orthop. 2023; 43(6):e476-e480. DOI: 10.1097/BPO.0000000000002400. View

20.

Jain A, Sullivan B, Shah S, Samdani A, Yaszay B, Marks M . Caregiver Perceptions and Health-Related Quality-of-Life Changes in Cerebral Palsy Patients After Spinal Arthrodesis. Spine (Phila Pa 1976). 2017; 43(15):1052-1056. DOI: 10.1097/BRS.0000000000002508. View