Si-yi CAI, Gui-xing QIU, Yi-peng WANG, Jian-guo ZHANG, Ye TIAN, Hong ZHAO, Yu ZHAO, Shu-gang LI, Jian-xiong SHEN, Mo-han LI. Enhanced Recovery after Surgery Program in the Perioperation of Adolescent Idiopathic Scoliosis and Its Effect Evaluation[J]. Medical Journal of Peking Union Medical College Hospital, 2019, 10(6): 594-599. DOI: 10.3969/j.issn.1674-9081.2019.06.008
Citation: Si-yi CAI, Gui-xing QIU, Yi-peng WANG, Jian-guo ZHANG, Ye TIAN, Hong ZHAO, Yu ZHAO, Shu-gang LI, Jian-xiong SHEN, Mo-han LI. Enhanced Recovery after Surgery Program in the Perioperation of Adolescent Idiopathic Scoliosis and Its Effect Evaluation[J]. Medical Journal of Peking Union Medical College Hospital, 2019, 10(6): 594-599. DOI: 10.3969/j.issn.1674-9081.2019.06.008

Enhanced Recovery after Surgery Program in the Perioperation of Adolescent Idiopathic Scoliosis and Its Effect Evaluation

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  • Corresponding author:

    SHEN Jian-xiong Tel: 86-10-69152801, E-mail:sjxpumch@163.com

  • Received Date: August 12, 2018
  • Issue Publish Date: November 29, 2019
  •   Objective  The aim of this study was to summarize the integrated program of enhanced recovery after surgery (ERAS) in the perioperation of adolescent idiopathic scoliosis (AIS) and to evaluate its impact on the recovery.
      Methods  Among the continuous cohort of AIS patients who underwent the orthopedic surgery in Peking Union Medical College Hospital from January 2007 to January 2017, the initial 100(Cases 1-100, traditional group) and the last 100 cases (Cases 1193-1292, ERAS group) were enrolled in this study. The preoperative, intraoperative, and postoperative enhanced recovery managements were performed in the ERAS group. The related recovery indicators were compared between the two groups, including the length of stay, the postoperative length of stay, allogeneic blood transfusion, pain scores at the discharge, the incidence of complications within 30 days, and the incidence of unplanned reoperation within 1 year.
      Results  There was no statistical difference in gender, age, body mass index, surgical segment, and the incidence of unplanned reoperation within 1 year between the two groups. The length of stay and the postoperative length of stay in the traditional group were significantly longer than those in the ERAS group[Length of stay:traditional group (17.18±2.67)days, ERAS group (11.35±1.49)days, P < 0.05; Postoperative length of stay:traditional group (9.34±0.52)days, ERAS group (7.19±0.71)days, P < 0.05]. The percentage and volume of allogeneic blood transfusion in the traditional group were both higher than those in the ERAS group[Percentage:traditional group 41%(41/100), ERAS group 20%(20/100), P < 0.05; Volume:traditional group (1.43±0.39)U, ERAS group (0.59±0.12)U, P < 0.05]. The pain scores at the discharge of the traditional group[(3.40±0.63) points] was slightly higher than that of the ERAS group[(3.00±0.47) points] without the statistical significance.
      Conclusion  Proposal formulation of ERAS program for the surgical treatment of AIS might reduce hospital stay and blood transfusion, and accelerate recovery without increasing complications and reoperation.
  • [1]
    Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation[J]. Br J Anaesth, 1997, 78:11. http://www.ncbi.nlm.nih.gov/pubmed/9175983
    [2]
    Adamina M, Kehlet H, Tomlinson GA, et al. Enhanced recovery pathways optimize health outcomes and resource utilization:A meta-analysis of randomized controlled trials in colorectal surgery[J]. Surgery, 2011, 149:830-840. DOI: 10.1016/j.surg.2010.11.003
    [3]
    Aasvang EK, Luna IE, Kehlet H. Challenges in postdis-charge function and recovery:the case of fast-track hip and knee arthroplasty[J]. Br J Anaesth, 2015, 115:861-866. http://www.ncbi.nlm.nih.gov/pubmed/26209853
    [4]
    Tambe AD, Panikkar SJ, Millner PA, et al. Current concepts in the surgical management of adolescent idiopathic scoliosis[J]. Bone Joint J, 2018, 100-B:415-424. DOI: 10.1302/0301-620X.100B4.BJJ-2017-0846.R2
    [5]
    邱贵兴.特发性脊柱侧凸的PUMC(协和)分型系统[J].中华骨科杂志, 2003, 23:8. http://doi.med.wanfangdata.com.cn/qk/zhgkzz98200301001
    [6]
    Mandelbaum BR, Tolo VT, McAfee PC, et al. Nutritional deficiencies after staged anterior and posterior spinal reconstructive surgery[J]. Clin Orthop Relat Res, 1988, 234:5-11. http://www.onacademic.com/detail/journal_1000039199830110_f52c.html
    [7]
    Lalueza MP, Colomina MJ, Bago J, et al. Analysis of nutritional parameters in idiopathic scoliosis patients after major spinal surgery[J]. Eur J Clin Nutr, 2005, 59:720-722. DOI: 10.1038/sj.ejcn.1602126
    [8]
    仉建国, 王炜, 邱贵兴, 等.术前肺功能检查在脊柱侧凸手术治疗中的作用[J].中华外科杂志, 2004, 42:3. http://www.cqvip.com/Main/Detail.aspx?id=10879258
    [9]
    Brady M, Kinn S, Stuart P. Preoperative fasting for adults to prevent perioperative complications[J]. Cochrane Database Syst Rev, 2003, (4):CD004423.
    [10]
    Gordon ZL, Son-Hing JP, Poe-Kochert C, et al. Bipolar sealer device reduces blood loss and transfusion requirements in posterior spinal fusion for adolescent idiopathic scoliosis[J]. J Pediatr Orthop, 2013, 33:700-706. http://www.ncbi.nlm.nih.gov/pubmed/23812158
    [11]
    Pastorelli F, Di Silvestre M, Plasmati R, et al. The prevention of neural complications in the surgical treatment of scoliosis:the role of the neurophysiological intraoperative monitoring[J]. Eur Spine J, 2011, 20 Suppl 1:S105-S114. http://www.ncbi.nlm.nih.gov/pubmed/21416379
    [12]
    张圣洁, 徐梅, 赵琳, 等.脊柱侧弯患者术后使用经静脉自控镇痛的效果及影响因素分析[J].护理学报, 2011, 18:45-47. http://d.wanfangdata.com.cn/Periodical/nfhlxb201120016
    [13]
    张谊, 高娜.脊柱侧弯术后应用病人自控镇痛泵镇痛的护理研究[J].护理研究, 2007, 33:3031-3032. http://d.wanfangdata.com.cn/Periodical/sxhlzz200733012
    [14]
    蔡思逸, 沈建雄, 邱贵兴, 等.综合全程血液管理措施对骨科手术患者异体输血的影响[J].协和医学杂志, 2015, 6:286-290. http://d.wanfangdata.com.cn/Periodical/xhyx201504013
    [15]
    黄宇光.手术患者临床用血的挑战与对策[J].中国输血杂志, 2010, 23:764-765. http://www.cqvip.com/QK/97865X/201010/35843348.html
    [16]
    Liang SJ, Chua S, Fan Y, et al. Does intraoperative cell salvage system effectively decrease the need for allogeneic transfusions in scoliotic patients undergoing posterior spinal fusion? A prospective randomized study[J]. Eur Spine J, 2015, 24:270-275. DOI: 10.1007/s00586-014-3282-2
    [17]
    Nahtomi-Shick OKJ, Winters BD, Breder CD, et al. Does intraoperative fluid management in spine surgery predict intensive care unit length of stay?[J]. J Clin Anesth, 2001, 13:208-212. DOI: 10.1016/S0952-8180(01)00244-6
    [18]
    于健春.围手术期营养支持合理优化选择[J].中国实用外科杂志, 2012, 2:110-112. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgsywkzz201202004
    [19]
    陈亚萍, 梁艳彩.脊柱侧弯患者术后腹胀的观察及其影响因素分析[J].护理学杂志, 2011, 26:48-49. http://qikan.cqvip.com/Qikan/Article/Detail?id=39500798
    [20]
    Blanco JS, Perlman SL, Cha HS, et al. Multimodal painmanagement after spinal surgery for adolescent idiopathic scoliosis[J]. Orthopedics, 2013, 36:33-35. http://europepmc.org/abstract/med/23379574
    [21]
    Daffner SD, Beimesch CF, Wang JC. Geographic and demographic variability of cost and surgical treatment of idiopathic scoliosis[J]. Spine (Phila Pa 1976), 2010, 35:1165-1169. http://www.ncbi.nlm.nih.gov/pubmed/20421853/
    [22]
    Erickson MA, Morrato EH, Campagna EJ, et al. Variability in spinal surgery outcomesamong children's hospitals in theUnited States[J].J Pediatr Orthop, 2013, 33:80-90. DOI: 10.1097/BPO.0b013e318269c537
    [23]
    Yoshihara YD. Nationaltrends in spinal fusion for pediatricpatients with idiopathic scoliosis:demographics, blood transfusions, and in-hospital outcomes[J]. Spine, 2014, 39:1144-1150. http://europepmc.org/abstract/med/24732849
    [24]
    Blanco JS, Perlman SL, Cha HS, et al. Multimodal painmanagement after spinal surgery for adolescent idiopathic scoliosis[J]. Orthopedics, 2013, 36:33-35. http://europepmc.org/abstract/med/23379574
    [25]
    Yoshihara H, Paulino C, Yoneoka D. Predictors of increased hospital stay in adolescent idiopathic scoliosis patients undergoing posterior spinal fusion:analysis of national database[J]. Spine Deform, 2018, 6:226-230. http://europepmc.org/abstract/MED/29735130
    [26]
    向娜, 李杨.青少年特发性脊柱侧凸患者术后疼痛评估与控制的研究进展[J].解放军护理杂志, 2016, 22:29-32. http://www.cqvip.com/QK/83642X/201622/671057456.html
    [27]
    Fletcher ND, Shourbaji N, Mitchell PM, et al. Clinical and economic implications ofearly discharge following posteriorspinal fusion for adolescentidiopathic scoliosis[J]. J Child Orthop, 2014, 8:257-263. http://europepmc.org/abstract/med/24770995
    [28]
    Austin E, Sanders BA, Lindsay M, et al. Clinically significant psychological and emotional distress in 32% of adolescent idiopathic scoliosis patients[J]. Spine Deform, 2018, 6:435-440. http://europepmc.org/abstract/MED/29886916
    [29]
    Muhly WT, Sankar WN, Ryan K, et al. Rapid recovery pathway after spinal fusion for idiopathic scoliosis[J]. Pediatrics, 2016, 137:1-10. http://europepmc.org/abstract/MED/27009035
    [30]
    Sanders JO. CORR Insights®:patient factors are associated with poor short-term outcomes after posterior fusion for adolescent idiopathic scoliosis[J]. Clin Orthop Relat Res, 2015, 473:295-296.
    [31]
    Hassan N, Halanski M, Wincek J, et al. Blood management in pediatric spinal deformity surgery:review of a 2-year experience[J]. Transfusion, 2011, 51:2133-2141. http://www.ncbi.nlm.nih.gov/pubmed?term=HUNTINGTON+JOHN[au]
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