{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T21:01:20Z","timestamp":1781038880823,"version":"3.54.1"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2023,3,19]],"date-time":"2023-03-19T00:00:00Z","timestamp":1679184000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,3,19]],"date-time":"2023-03-19T00:00:00Z","timestamp":1679184000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100006034","name":"University of Southern California","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100006034","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Spine Deform"],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>Prior studies of enhanced recovery protocols (ERP) have been conducted at large institutions with abundant resources. These results may not apply at institutions with less resources directed to quality improvement efforts. The purpose of this study was to assess the value of a minimalistic enhanced recovery protocol in reducing length of stay (LOS) following PSF for adolescent idiopathic scoliosis. We hypothesized that accelerated transition to oral pain medications and mobilization alone could shorten hospital length of stay in the absence of a formal multimodal pain regimen.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>AIS patients aged 10\u201318 who underwent PSF at a tertiary pediatric hospital between January 1, 2014 and December 31, 2017 were reviewed. The study population was further narrowed to consecutive patients from a single surgeon\u2019s practice that piloted the modified ERP. Reservation from key stakeholders regarding the feasibility of implementing widespread protocol change led to the minimal alterations made to the postoperative protocol following PSF. Patients were divided into either the Standard Recovery Protocol (SRP) or Enhanced Recovery Protocol (ERP). Primary variables analyzed were hospital LOS, complications, readmissions, and total narcotic requirement.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>A total of 92 patients met inclusion criteria. SRP and ERP groups consisted of 44 (47.8%) and 48 (52.2%) patients. There was no difference between the two groups with regard to age, sex, and ASA score (<jats:italic>p<\/jats:italic>\u2009&gt;\u20090.05). Fusion levels and EBL did not differ between treatment groups (<jats:italic>p<\/jats:italic>\u2009&gt;\u20090.05). PCA pumps were discontinued later in the SRP group (39.5\u2009\u00b1\u20094.3\u00a0h) compared to the ERP group (17.4\u2009\u00b1\u20094.1\u00a0h, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001). Narcotic requirement was similar between groups (<jats:italic>p<\/jats:italic>\u2009=\u20090.94) Patients in the SRP group had longer hospital stays than patients in the ERP group (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001). 83% of the ERP group had LOS\u2009\u2264\u20093\u00a0days compared to 0% in the SRP group, whose mean LOS was 4.2\u00a0days. There was no difference in complications between the groups (2.2% vs 6.0%, <jats:italic>p<\/jats:italic>\u2009=\u20090.62). Readmission to the hospital within 30\u00a0days of surgery was rare in either group (2 SRP patients: 1 superior mesenteric artery syndrome, 1 bowel obstruction vs 0 ERP patients, <jats:italic>p<\/jats:italic>\u2009=\u20090.23).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>In this cohort, minor changes to the postoperative protocol following surgery for AIS led to a significant decrease in hospital length of stay. This minimalistic approach may ease implementation of an ERP in the setting of stakeholder apprehension.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s43390-023-00675-0","type":"journal-article","created":{"date-parts":[[2023,3,19]],"date-time":"2023-03-19T18:02:43Z","timestamp":1679248963000},"page":"841-846","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Minimalistic approach to enhanced recovery after pediatric scoliosis surgery"],"prefix":"10.1007","volume":"11","author":[{"given":"Scott A.","family":"Barnett","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryant M.","family":"Song","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Bauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew E.","family":"Nungesser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Leonardi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0632-3367","authenticated-orcid":false,"given":"Michael J.","family":"Heffernan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,3,19]]},"reference":[{"issue":"3","key":"675_CR1","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1002\/bjs.9394","volume":"101","author":"A Nicholson","year":"2014","unstructured":"Nicholson A, Lowe MC, Parker J et al (2014) Systematic review and meta-analysis of enhanced recovery programmes in surgical patients. 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None of the authors received financial support for this study. All the authors have no conflicts of interest relevant to this submission.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Office for Protection of Human Subjects (IRB) of Children\u2019s Hospital New Orleans approved this study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval\/research involving human participants and\/or animals"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Not applicable.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Informed consent is exempted due the retrospective, exempted nature of the study.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}