Lorena V Floccari, Michael T Bigham, Matthew Holloway, Kenzie D Lundqvist, Alexandria Rundell, Richard P Steiner, Kenneth T Bono, Todd F Ritzman
{"title":"Longitudinal impact of a perioperative pathway for spinal fusion in adolescent idiopathic scoliosis: a quality improvement project.","authors":"Lorena V Floccari, Michael T Bigham, Matthew Holloway, Kenzie D Lundqvist, Alexandria Rundell, Richard P Steiner, Kenneth T Bono, Todd F Ritzman","doi":"10.1007/s43390-024-01032-5","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Prior studies show that recovery pathway implementation after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) reduces length of stay (LOS) without increasing complications, but little is known about the sustainability and longitudinal outcomes of these initiatives. This study aimed to establish and continually improve a perioperative pathway for AIS patients undergoing PSF while tracking long-term LOS performance with iterative improvements.</p><p><strong>Methods: </strong>Implementation of the AIS care pathway at a single freestanding tertiary children's hospital was initiated in January 2016 (Phase 1) with iterative annual changes and a comprehensive update in September 2021 (Phase 2). The pathway involves preoperative optimization, standardized protocols, multi-modal pain regimen, early transition to oral pain medications, and early and frequent mobilization. Outcomes were tracked longitudinally using quality-improvement methodology, and comparisons between each group were performed.</p><p><strong>Results: </strong>Four hundred thirty six AIS patients (86 pre-implementation, 257 Phase 1, 93 Phase 2) who underwent PSF were included. Baseline patient demographics and Cobb angles were similar. Hospital LOS decreased from 5.1 days pre-implementation to 2.3 days in a stepwise fashion corresponding with pathway modifications. Intensive care unit (ICU) admissions decreased from 100% pre-implementation to 0% during Phase 2. Perioperative order set compliance increased from 0% pre-implementation to 100%. There were no significant increases in readmissions or reoperations. Direct hospitalization costs decreased by $5854.95 per case.</p><p><strong>Conclusions: </strong>A multidisciplinary perioperative pathway for AIS patients undergoing PSF significantly reduced hospital LOS by 55% and direct costs by 11.3%. Continuous improvement and data monitoring led to sustained positive outcomes over eight years.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6000,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Spine deformity","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s43390-024-01032-5","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: Prior studies show that recovery pathway implementation after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) reduces length of stay (LOS) without increasing complications, but little is known about the sustainability and longitudinal outcomes of these initiatives. This study aimed to establish and continually improve a perioperative pathway for AIS patients undergoing PSF while tracking long-term LOS performance with iterative improvements.
Methods: Implementation of the AIS care pathway at a single freestanding tertiary children's hospital was initiated in January 2016 (Phase 1) with iterative annual changes and a comprehensive update in September 2021 (Phase 2). The pathway involves preoperative optimization, standardized protocols, multi-modal pain regimen, early transition to oral pain medications, and early and frequent mobilization. Outcomes were tracked longitudinally using quality-improvement methodology, and comparisons between each group were performed.
Results: Four hundred thirty six AIS patients (86 pre-implementation, 257 Phase 1, 93 Phase 2) who underwent PSF were included. Baseline patient demographics and Cobb angles were similar. Hospital LOS decreased from 5.1 days pre-implementation to 2.3 days in a stepwise fashion corresponding with pathway modifications. Intensive care unit (ICU) admissions decreased from 100% pre-implementation to 0% during Phase 2. Perioperative order set compliance increased from 0% pre-implementation to 100%. There were no significant increases in readmissions or reoperations. Direct hospitalization costs decreased by $5854.95 per case.
Conclusions: A multidisciplinary perioperative pathway for AIS patients undergoing PSF significantly reduced hospital LOS by 55% and direct costs by 11.3%. Continuous improvement and data monitoring led to sustained positive outcomes over eight years.
期刊介绍：
Spine Deformity the official journal of the?Scoliosis Research Society is a peer-refereed publication to disseminate knowledge on basic science and clinical research into the?etiology?biomechanics?treatment?methods and outcomes of all types of?spinal deformities. The international members of the Editorial Board provide a worldwide perspective for the journal's area of interest.The?journal?will enhance the mission of the Society which is to foster the optimal care of all patients with?spine?deformities worldwide. Articles published in?Spine Deformity?are Medline indexed in PubMed.? The journal publishes original articles in the form of clinical and basic research. Spine Deformity will only publish studies that have institutional review board (IRB) or similar ethics committee approval for human and animal studies and have strictly observed these guidelines. The minimum follow-up period for follow-up clinical studies is 24 months.
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