Scholarlink

Objective <p>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> Methods <p>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> Results <p>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&#xa0;days pre-implementation to 2.3&#xa0;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> Conclusions <p>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> Level of evidence <p>III.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Longitudinal impact of a perioperative pathway for spinal fusion in adolescent idiopathic scoliosis: a quality improvement project

  • 期刊论文

  • 发表日期：

    2025年3月25日

查看全文
  • Lorena V. Floccari,
  • Michael T. Bigham,
  • Matthew Holloway,
  • Kenzie D. Lundqvist,
  • Alexandria Rundell,
  • Richard P. Steiner,
  • Kenneth T. Bono,
  • Todd F. Ritzman

摘要

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.

Level of evidence

III.