Feasibility and Outcome of an Accelerated Recovery Protocol in Asian Adolescent Idiopathic Scoliosis Patients

Study Design. A prospective cohort study. Objective. The aim of this study was to determine the feasibility of an accelerated recovery protocol for Asian adolescent idiopathic scoliosis (AIS) patients undergoing posterior spinal fusion (PSF). Summary of Background Data. There has been successful implementation of an accelerated recovery protocol for AIS patients undergoing PSF in the western population. No similar studies have been reported in the Asian population. Methods. Seventy-four AIS (65 F, 9 M) patients scheduled for PSF surgery were recruited. The accelerated protocol encompasses preoperative regime, preoperative day of surgery counseling, intraoperative strategies, an accelerated postoperative rehabilitation and pain management regime. All patients were operated using a dual attending surgeon strategy. Outcome measures included pain scores at five time intervals, length of stay, and detailed recovery milestones. Any complications or readmissions during the first 4 months postoperative period were recorded. Results. Mean duration of operation was 2.2 +/- 0.3 hours with a mean blood loss of 824.3 +/- 418.2mL. No patients received allogenic blood transfusion. The mean length of stay was 3.6 +/- 0.6 days. Surgical wound pain score was 6.4 +/- 2.1 at 12 hours, which reduced to 5.0 +/- 2.0 at 60 hours. Abdominal pain peaked at 36 hours with pain scores 2.4 +/- 2.9. First liquid intake was at 5.2 +/- 7.5 hours, urinary catheter removal at 18.7 +/- 4.8 hours, sitting up at 20.6 +/- 9.1 hours, ambulation at 27.2 +/- 0.5 hours, consumption of solid food at 32.2 +/- 0.5 hours, first flatus at 39.0 +/- 0.7 hours, and first bowel movement at 122.1 +/- 2.0 hours. The complication rate was 1.4% due to superficial wound infection with one patient failed to comply with the accelerated protocol. Conclusion. An accelerated recovery protocol following PSF for AIS is feasible without increasing the complication or readmission rates. The total length of stay was 3.6 days and this is comparable with the outcome in western population.