Enhanced recovery after surgery (ERAS) protocol for scoliosis leads to improved postoperative outcome and earlier discharge from hospital

Abstract

Introduction: Enhanced recovery surgery (ERAS) is a multidimensional approach to improving the care of surgical patients using subspecialty and procedure-specific protocols to expedite functional recovery, decrease postoperative morbidity and improve patient’s experience. There is no study examining the effect of ERAS in younger patients undergoing scoliosis surgery. Materials and Methods: A retrospective evaluation of the current ERAS protocol used at Gleneagles Hospital (GHK) compared to standard care used at Hospital Authority (HA) The GHK ERAS protocol involves a multidimensional approach before, during and after surgery. Outcome measure involves pain score, time to normal diet, time to self-mobilisation and total length of hospital stay. Total of 18 matched cohort patients was selected. 10 patients received standardised care currently offered at Hospital Authority and eight patients received care under the GHK ERAS protocol. Results: Patient age and fusion length were similar in HA and ERAS. Pain score was 4.4 (HA) vs 3.75 (ERAS), Time to sitting was 1.5 days (HA) vs 1.125 days (ERAS), Time to self-mobilisation was 2.7 days (HA) vs 1.625 days (ERAS), Nausea and vomiting was found in 40% patients (HA) vs 25% of patients (ERAS). Time to normal diet after surgery was 1.2 days for HA and 0.5 days for ERAS. The average length of stay was 6.6 days for HA and 4.75 days for ERAS. Discussion and Conclusion: This pilot study showed that the use of a standardised protocol with ERAS principles improves patient’s outcome by reducing postoperative pain, expediting mobilisation and reducing hospital stay.