Development of an Integrative Medicine Perioperative Program to Address Stressors Amongst Adolescents Undergoing Orthopedic Surgery: A Pilot Study

Background: Adolescents account for the greatest percentage of post-surgical pediatric discharges, and of these, orthopedic patients are the second-largest cohort. These patients experience significant perioperative stressors which influence immediate post-operative outcomes. Evidence suggests a connection between preoperative anxiety and sleep disturbance, development of opioid use disorders, and other maladaptive behaviors that can extend even years beyond the hospitalization for the surgical procedure. These symptoms can occur prior to surgery, during the hospital course, and even after discharge. About one-third of Americans already use some form of IM, and adolescents are the largest pediatric group. Of the many IM techniques, mind-body practices have a low prevalence of adverse effects and promote physiologic self-regulation, presenting an opportunity for use during the perioperative period. Development of an IM program for adolescents in the perioperative setting provides a novel approach to improving their care.

Methods: This study is working to determine the potential of a novel, comprehensive, non-pharmacologic skill-based IM program to reduce perioperative stress in adolescents undergoing routine orthopedic surgery. Self-reported pilot data on overall stress of the experience will be collected and compared to data gathered after implementation of the program. Pilot data will be analyzed and evaluated as preparation for a future multi-institutional implementation of this novel program for use with adolescents undergoing many types of surgery.

Results: Specific Hypotheses: We hypothesize that implementation of a novel, non-pharmacologic, skill-based perioperative IM program will reduce self-reported perioperative stress scores in adolescents undergoing elective orthopedic surgery. Specifically, subaim 1.1 will test the hypothesis that our patients experience perioperative stressors that manifest as pain, anxiety and abdominal discomfort, and can be quantified using age-validated scoring mechanisms. Our second hypothesis, which will be tested in subaim 1.2, is that participation in our novel non-pharmacologic skill-based IM program will decrease stress scores both pre- and perioperatively, decrease total post-operative opioid and anti-emetic use, decrease LOS, decrease cost of care, and increase patient satisfaction.

Conclusion: The data will be used to determine the likely effect size of the IM intervention on the TSS of patients who participate in the program compared to those who do not, and determine the power needed for a future multi-institutional study. We will assume the mean values ±standard deviations of the change of scores from the study outset to the end of follow-up are 15 ± 10 and 25 ±10 in the pre- and post- implementation groups, respectively. A sample size of 17 in each group will have 80% power to detect the proposed difference (with significance level of 0.05). Assuming the loss-to follow-up rate is 20%, we plan to recruit 21 subjects in each group.