We might be seeing some progress when it comes to finding that “sweet spot” between rehab speed and safety. A new multicenter work, “Rapid Recovery Pathway for Postoperative Treatment of Adolescent Idiopathic Scoliosis,” offers evidence of such and appears in the Journal of the American Academy of Orthopasedic Surgeons Global Research and Reviews.
Co-author Juston Fan, D.O., a third-year orthopedic surgery resident at Riverside University Health System Medical Center, explained the origin of the study to OTW, “We wanted to contribute to the literature regarding postoperative pain management of adolescent idiopathic scoliosis [AIS], as there has been a lot of research regarding decreasing narcotic pain consumption and decreasing health care costs in the United States. We theorized that the rapid recovery pathway (RRP) for the postoperative management of adolescent idiopathic scoliosis in our institution was a viable protocol that encouraged earlier mobilization and would decrease length of stay.”
So, the Riverside University team designed and instituted a retrospective review of two patient cohorts (conventional pathway or Rapid Recovery Pathway) who were diagnosed with adolescent idiopathic scoliosis who’d undergone posterior spinal fusion surgery. The same surgeon performed all of the surgeries with no variations in technique, technology, or implants.
Rapid recovery pathway is a novel multimodal analgesic platform with accelerated rehabilitation, which has been implemented in many institutions to better control pain with less narcotic use, ultimately leading to a quicker recovery.
Those in the rapid recovery pathway cohort had a shorter length of stay (3.3 days) as compared to those in the conventional pathway (4.4 days). The Rapid Recovery Pathway group also had significantly shorter time to Foley catheter removal, (difference of 0.85 days). The rapid recovery pathway group also shone in the physical therapy clearance arena (2.2 days versus 3.5 days).”
“The most important result,” said Dr. Fan to OTW, “is that this protocol allowed for decreased length of stay, earlier mobilization with physical therapy, and showed lower overall postoperative pain scores, despite no difference in narcotic consumption. Our initial hopes were that the RRP group would also show a lower narcotic consumption, but our data showed no difference.”
Going Forward
“We would further examine patient-reported outcomes, patient and parent satisfaction, narcotic use post-discharge from the hospital, at two weeks, a month, three months, etc. The more data points that could be examined would further elucidate just how quickly patients are recovering from this type of surgery. Our study is encouraging and I’m confident that more institutions will adopt similar protocols in postoperative pain management for other procedures as we continue to explore this topic. Our hope is that future research will continue to examine ways of allowing our patients to recover faster, while maximizing successful outcomes and minimizing postoperative pain and narcotic consumption.”
