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Meta-Analysis
. 2021 Jul;9(4):893-904.
doi: 10.1007/s43390-021-00310-w. Epub 2021 Mar 16.

Enhanced recovery after surgery (ERAS) in adolescent idiopathic scoliosis (AIS): a meta-analysis and systematic review

Akshay D Gadiya  1 , Jonathan E J Koch  2 , Mohammed Shakil Patel  2 , Masood Shafafy  2 , Michael P Grevitt  2 , Nasir A Quraishi  2
Affiliations
Meta-Analysis

Enhanced recovery after surgery (ERAS) in adolescent idiopathic scoliosis (AIS): a meta-analysis and systematic review

Akshay D Gadiya et al. Spine Deform. 2021 Jul.

Abstract

Study design: A systematic review reporting on the efficacy of an ERAS protocol in patients undergoing spinal fusion for AIS.

Objective: To systematically evaluate the relevant literature pertaining to the efficacy of ERAS protocols with respect to the length of stay, complication, and readmission rates in patients undergoing posterior spinal corrective surgery for AIS. ERAS is a multidisciplinary approach aimed at improving outcomes of surgery by a specific evidence-based protocol. The rationale of this rapid recovery regimen is to maintain homeostasis so as to reduce the postoperative stress response and pain. No thorough review of available information for its use in AIS has been published.

Methods: A systematic review of the English language literature was undertaken using search criteria (postoperative recovery AND adolescent idiopathic scoliosis) using the PRISMA guidelines (Jan 1999-May 2020). Isolated case reports and case series with < 5 patients were excluded. Length of stay (LOS), complication and readmission rates were used as outcome measures. Statistical analysis was done using the random effects model.

Results: Of a total of 24 articles, 10 studies met the inclusion criteria (9 were Level III and 1 of level IV evidence) and were analyzed. Overall, 1040 patients underwent an ERAS-type protocol following posterior correction of scoliosis and were compared to 959 patients following traditional protocols. There was a significant reduction in the length of stay in patients undergoing ERAS when compared to traditional protocols (p < 0.00001). There was no significant difference in the complication (p = 0.19) or readmission rates (p = 0.30). Each protocol employed a multidisciplinary approach focusing on optimal pain management, nursing care, and physiotherapy.

Conclusion: This systematic review demonstrates advantages with ERAS protocols by significantly reducing the length of stay without increasing the complications or readmission rates as compared to conventional protocols. However, current literature on ERAS in AIS is restricted largely to retrospective studies with non-randomized data, and initial cohort studies lacking formal control groups.

Level of evidence: 3.

Keywords: Adolescent idiopathic scoliosis; Enhanced recovery after surgery; Fast-track recovery; Posterior spinal fusion.

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Conflict of interest statement

There are no conflicts of interest.

Figures

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PRISMA chart for systematic review of database
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Analysis of age
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Analysis of operative time
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Analysis of number of levels fused
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Analysis of preoperative magnitude of main curve
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Analysis of blood loss
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Analysis of length of stay
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Analysis of complication rate
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Analysis of readmission rate
See this image and copyright information in PMC

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References

    1. Blanco JS, Perlman SL, Cha HS, et al. Multimodal pain management after spinal surgery for adolescent idiopathic scoliosis. Orthopedics. 2013;36(2 suppl):33e5. - PubMed
    1. Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg. 2017;152:292–298. doi: 10.1001/jamasurg.2016.4952. - DOI - PubMed
    1. Elsarrag M, Soldozy S, Patel P, et al. Enhanced recovery after spine surgery: a systematic review. Neurosurg Focus. 2019;46(4):E3. doi: 10.3171/2019.FOCUS18700. - DOI - PubMed
    1. Bannister M, Ah-See KW. Enhanced recovery programmes in head and neck surgery: systematic review. J Laryngol Otol. 2015;129:416–420. doi: 10.1017/S0022215115000936. - DOI - PubMed
    1. Barton JG. Enhanced recovery pathways in pancreatic surgery. Surg Clin N Am. 2016;96:1301–1312. doi: 10.1016/j.suc.2016.07.003. - DOI - PubMed