Enhancing Recovery in Severe Adolescent Idiopathic Scoliosis (AIS) Patients With Cobb Angle ≥90 Degrees Undergoing Single-staged Posterior Spinal Fusion (PSF): Evaluating the Feasibility of Rapid Recovery Protocol (RRP)

Saturveithan Chandirasegaran; Chris Yin Wei Chan; Chee Kidd Chiu; Siti Mariam Mohamad; Mohd Shahnaz Hasan; Mun Keong Kwan

doi:10.1097/BSD.0000000000001755

Enhancing Recovery in Severe Adolescent Idiopathic Scoliosis (AIS) Patients With Cobb Angle ≥90 Degrees Undergoing Single-staged Posterior Spinal Fusion (PSF): Evaluating the Feasibility of Rapid Recovery Protocol (RRP)

Clin Spine Surg. 2025 Jan 3. doi: 10.1097/BSD.0000000000001755. Online ahead of print.

Authors

Saturveithan Chandirasegaran¹, Chris Yin Wei Chan¹, Chee Kidd Chiu¹, Siti Mariam Mohamad¹, Mohd Shahnaz Hasan², Mun Keong Kwan¹

Affiliations

¹ Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
² Department of Anesthesiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.

PMID: 39749929
DOI: 10.1097/BSD.0000000000001755

Abstract

Study design: Retrospective study.

Objective: To assess the feasibility and outcome of rapid recovery protocol (RRP) in severe adolescent idiopathic scoliosis (AIS) patients with Cobb angle ≥90 degrees underwent single-staged posterior spinal fusion (PSF).

Summary of background data: Corrective surgeries in severe AIS patients entail a higher risk of prolonged operation, excessive bleeding, extended hospital stay, and higher complication rates compared with non-severe AIS patients. Implementation of RRP among severe AIS patients has not been reported.

Methods: Thirty-seven severe AIS patients who underwent single-staged PSF surgery from 2019 to 2022 were recruited. The RRP consisted of a preoperative regime and counselling, intraoperative strategies to reduce operation duration and blood loss and an accelerated postoperative rehabilitation pathway. Outcome measures were operative time, blood loss, postoperative pain scores, patient-controlled analgesia (PCA) morphine usage, length of hospital stay, and recovery milestones. Descriptive statistics were reported in mean (SD) for numerical data, whereas categorical data were presented in n (%).

Results: The mean operation duration was 173.5±39.4 minutes, and the mean blood loss was 1064.6±473.3 mL. The average postoperative hospital stay was 3.2±0.6 days. Twelve hours post-operation pain score was 4.0±2.0 and reduced to 3.9±1.6 at 48 hours. 78.4% of patients discontinued their PCA at 48 hours. First liquid intake was at 6.3±8.5 hours, whereas solid food consumption was initiated at 23.4±14.2 hours. The urinary catheter was removed at 17.8±7.6 hours. Patients started ambulation at 24±12.7 hours, first passed flatus at 37.7±20.4 hours and had their first bowel movement at 122.1±41.7 hours. Three complications (8.1%) were reported, which included superficial surgical site infection, proximal wound stitch abscess and superficial thermal injury due to forced air-warming blanket.

Conclusion: The implementation of the RRP after PSF in severe AIS patients was feasible and resulted in a short postoperative hospital stay of 3.2 days without increasing the risk of major complications, readmissions, and reoperations.