Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis Pathway Background and Objective(s): Posterior spinal fusion for adolescent idiopathic scoliosis is associated with significant pain and prolonged hospitalization. Standardizing care for posterior spinal fusion can allow early mobilization, decreased LOS, and minimize opioid related side effects. We also wish to determine if a multimodal analgesia approach improves pain control, as such an approach has helped patients after a “Nuss procedure” (chest repair surgery) use less pain medication and have a quicker recovery postoperatively. The specific objectives of this pathway are to: Standardize inpatient post op care Promote early mobilization Decrease length of stay Minimize opioid related side effects Determine if a multimodal analgesia approach improves pain control Algorithm: Download Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis Algorithm Updated July 27, 2021 Quality Metrics: Length of time on opioid PCA Gabapentin script written prior to admission for surgery Length of stay (LOS) Overall LOS for all patients Breakdown of LOS by #vertebrae fused Number of post-op infections Length of time from functional clearance until discharge Opioid dose per day in morphine equivalents Number of pain scores above a 6/10 in a 24-hour period Educational Module: Download Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis Module Updated June 16, 2021 Key References: Gauger VT, Voepel-Lewis TD, Burke CN, Kostrzewa AJ, Caird MS, Wagner D S, Farley FA. Epidural Analgesia Compared With Intravenous Analgesia After Pediatric Posterior Spinal Fusion. J Pediatr Orthop. 2009 Sep;29(6):588–93. Muhly WT, Sankar WN, Ryan K, et al. Rapid Recovery Pathway After Spinal Fusion for Idiopathic Scoliosis. Pediatrics. 2016 Apr;137(4):e20151568. doi: 10.1542/peds.2015-1568. Oetgen ME, Shirley ED, Choi PD, Sanders JO. Common Elements in Surgical Site Infection Care Bundles for Adolescent Idiopathic Scoliosis at North American Pediatric Institutions: A Survey of POSNA QSVI Challenge Participants. J Pediatr Orthop. 2019 Aug;39(7):e514-519. Sheffer BW, Kelly DM, Rhodes LN, Sawyer JR. Perioperative Pain Management in Pediatric Spine Surgery. Orthop Clin North Am. 2017 Oct;48(4):481–486. Vandenberg C, Niswander C, Carry P, et al. Compliance With a Comprehensive Antibiotic Protocol Improves Infection Incidence in Pediatric Spine Surgery. J Pediatr Orthop. May/Jun 2018;38(5):287–292. Pathway Contacts: Taryn J Hamre, DNP, APRN – Pain and Palliative Medicine William Zempsky, MD – Pain and Palliative Medicine Jeffrey Thomson, MD – Orthopedics Mark Lee, MD – Orthopedics Ana Verissimo, MD – Integrative Medicine Kim Koenig, PT – Physical Therapy Disclaimer The clinical pathways in the above links have been developed specifically for use at Connecticut Children’s and are made available publicly for informational and/or educational purposes only. The clinical pathways are not intended to be, nor are they, a substitute for individualized professional medical judgment, advice, diagnosis, or treatment. Although Connecticut Children’s makes all efforts to ensure the accuracy of the posted content, Connecticut Children’s makes no warranty of any kind as to the accuracy or completeness of the information or its fitness for use at any particular facility or in any individual case. View all Clinical Pathways >
