O1047: Does a Dedicated a “scoliosis Team” and Surgical Standardization Improve Outcomes in Adolescent Idiopathic Scoliosis Surgery and Is It Reproducible?

Background: Standardized protocols in spine surgeries have been shown to increase patient safety and outcomes. Surgical correction of adolescent idiopathic scoliosis (AIS) is a high-risk procedure with potential complications including blood loss, long surgery duration, and neurological complications. Expedited recovery after surgery protocols and the perioperative surgical home are two initiatives that address the need for increased efficiency in patient care. In 2011, we implemented a standardized approach including a “scoliosis team” of dedicated anesthesiologists, operating room nurses, surgical technicians, and neurophysiologists. We also implemented a standardized pre-operative work-up, specific intraoperative protocols including the use of anti-fibrinolytics and intrathecal morphine, and a multi-disciplinary postoperative care model. The purpose of this study is to determine if standardization improves AIS surgery outcomes and whether it is transferrable between institutions.

Methods: A retrospective review was conducted of a prospective AIS database from 2009-2018 at 2 institutions (IA and IB). In each institution, a non-standardized group (NST) and a standardized group (ST), were compared. Demographics and perioperative outcomes were recorded. In 2015, the surgeons changed institutions (to IB). Reproducibility was determined between institutions (IA vs. IB). Median (IQR), Kruskal-Wallis, and Fisher’s exact test were used.

Results: 325 AIS patients were collected from the database. The non-standardized group (NST) included 44 patients, while the standardized group (ST) included 281 patients. Age (p=0.21), BMI (p=0.48), preoperative Cobb angle (p=0.48), levels fused (p=0.42), and correction percentage (p=0.39) were all similar. Standardized protocol patients had lower estimated blood loss (EBL) (700 ml vs 325 ml, p< 0.001), shorter anesthesia time (437 min vs 384 min, p=0.004), shorter surgical time (310 min vs 248 min, p< 0.001), and shorter length of stay (LOS) (7 days vs 5 days, p< 0.001).
IA (n=101) and IB (n=105) were compared. Age (p=0.21), BMI (p=0.48) and preoperative Cobb angle (p=0.48) were similar. EBL (p < 0.001), anesthesia time (p < 0.001), surgical time (p < 0.001), and LOS (p < 0.001) were significantly lower in IB.

Conclusion: Standardization of the perioperative approach for AIS correction with a dedicated team resulted in significantly decreased blood loss, surgical time, and length of stay. These results occurred as the team continued to refine the protocol over the course of the study duration. The ability to implement these changes across multiple institutions while continuing to improve perioperative outcomes demonstrates the reproducibility of this protocol. A standardized AIS approach including a dedicated operative team, pre-operative work up, postoperative multi-disciplinary management, and streamlined surgical steps improves outcomes and efficiency.