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Observational Study
. 2025 Apr 15;26(8):3723.
doi: 10.3390/ijms26083723.

Clinical Outcomes and Inflammatory Response to the Enhanced Recovery After Surgery (ERAS) Protocol in Adolescent Idiopathic Scoliosis Surgery: An Observational Study

Francesca Salamanna  1 , Giuseppe Tedesco  2 , Maria Sartori  1 , Deyanira Contartese  1 , Emanuela Asunis  2 , Chiara Cini  2 , Francesca Veronesi  1 , Konstantinos Martikos  2 , Milena Fini  3 , Gianluca Giavaresi  1 , Alessandro Gasbarrini  2   4
Affiliations
Observational Study

Clinical Outcomes and Inflammatory Response to the Enhanced Recovery After Surgery (ERAS) Protocol in Adolescent Idiopathic Scoliosis Surgery: An Observational Study

Francesca Salamanna et al. Int J Mol Sci. .

Abstract

Limited data exist on the clinical outcomes and inflammatory response of Enhanced Recovery After Surgery (ERAS) protocols in adolescent idiopathic scoliosis (AIS) patients undergoing posterior spinal fusion (PSF). This study evaluates ERAS's impact by analyzing blood parameters and serum protein, surgical, and radiological parameters to assess safety, feasibility, and clinical outcomes. Between July 2021 and July 2022, 30 AIS patients underwent PSF with standardized pain management, high-dose tranexamic acid, early mobilization, and reduced opioid use. Blood tests and serum markers (IL-6, IL-1β, IL-1α, IL-10, TNF-α, IL-8, PGE2) were measured preoperatively and on postoperative day 2. Pain levels (VAS) were recorded preoperatively, on postoperative days 1 and 2, and at discharge. Results showed increased postoperative white blood cell counts, reduced hemoglobin and hematocrit, and elevated C-reactive protein levels. IL-6 was the only inflammatory marker significantly elevated, indicating a controlled inflammatory response. Pain peaked on day 1 but significantly decreased by discharge, confirming the effectiveness of multimodal analgesia. The average hospital stay was 6.97 ± 2.03 days, with low rehospitalization (6.66%) and manageable complications (20%). In conclusion, ERAS effectively optimizes AIS patient recovery, stabilizing pain, reducing complications, and improving perioperative care.

Keywords: adolescent idiopathic scoliosis; clinical outcomes; enhanced recovery after surgery; inflammatory response; observational study.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Pre- (A) and postoperative (B) radiographs of representative case with 13-year-old female patient. (A) Preoperative standing Cobb angle of 64° and (B) postoperative standing Cobb angle of 14°.
Figure 2
Figure 2
Plot of VAS score evaluated preoperatively, 1 and 2 days after surgery and at discharge. (*) p  <  0.05, (**) p  <  0.005, (***) p  <  0.0005.
Figure 3
Figure 3
ELISA release of IL-1β, IL-1α, IL-6, IL-8, IL-10, TNF-α, and PGE2 pre-operatively and 2 days after surgery. Student’s t-test among pre-operative and post-operative time. Results were expressed as mean ± standard deviation (SD). IL6: pre-op versus post-op, (*) p  <  0.05.
Figure 4
Figure 4
Schematic representation of ERAS pathway used in this study.
See this image and copyright information in PMC

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