P93
MULTIDISCIPLINARY ERAS PROTOCOL SHORTENS LENGTH OF STAY AND EARLIER MOBILISATION AFTER AIS CORRECTION AND FUSION SURGERY
R. J. Morris, J. Morgan, R. Jayasuriya
Sheffield Children’s Hospital, UK
Introduction:
Enhanced Recovery After Surgery (ERAS) is a multidisciplinary evidence-based approach to perioperative care to improve patient outcomes which has been well described across a range of surgical specialties (1). A systematic review looking at the use of ERAS in scoliosis surgery showed a significant reduction in length of stay (LOS) without any increase in complication or readmission rate. Early mobilisation, multimodal analgesia and early removal of drains/ urinary catheters were common to all reported protocols (2).
We introduced a multidisciplinary ERAS program for patients with adolescent idiopathic scoliosis (AIS) with the aim of improving patient reported outcomes and reducing LOS.
Method:
Qualitative patient feedback survey of patients undergoing surgery for AIS highlighted the need for a goal directed, multidisciplinary approach to recovery in our hospital. This feedback, along with an ERAS proposal was presented to engage stakeholders at the spine MDT.
A jointly produced patient information leaflet was given to families to guide expectations. Awareness of the new pathway was raised in governance meetings and education provided for staff prior to its introduction. Comments and opinions regularly sought through multidisciplinary forums to ensure effective pathway delivery, with repeated PDSA cycles allowing refinement of the protocol. A patient flip chart with daily aims in partnership with physiotherapy was produced to empower patients and staff, allowing easy communication and highlighting where more support was needed.
Prospective audit of compliance to ERAS targets was carried out. Length of stay data was compared with data from 2013 to assess impact.
Results:
During a 12-month period in 2013, 32 patients underwent scoliosis correction surgery for AIS with a median LOS of 7 days. Following the introduction of the ERAS pathway, 46 patients underwent surgery in a 12-month period with a median LOS of 4 days.
ERAS targets and outcomes:
Drinking on day 0 achieved by 78%, with 84% eating on day 1. PCA stopped by day 2 was achieved by 83%, with IVI discontinued by day 2 in 67% and catheter removed in 57%. Physiotherapy targets included sitting by day 1 (achieved by 91%) and walking by day 3 (89%).
Discussion:
Introduction of ERAS for this cohort of patients has significantly reduced median LOS from 7 to 4 days.
A goal directed; multidisciplinary approach was key to successful implementation. Regular multidisciplinary meetings enabled swift identification of problems faced on the ward and barriers to early mobilisation, enabling ongoing adaptation.
Introduction of patient orientated, goal-directed flash cards encouraged active engagement and enabled effective communication between all members of the MDT. Following the successful implementation of this ERAS program for AIS patients its use will be expanded to all ambulatory non-AIS scoliosis patients.
References:
- Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg. 2017;152:292–298. doi: 10.1001/jamasurg.2016.4952
- Gadyia A, Koch J et al. Enhanced recovery after surgery (ERAS) in adolescent idiopathic scoliosis (AIS) : a meta-analysis and systematic review Spine Deform 2021; 9(4):893-904