Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

Pathway Background and Objectives

Posterior spinal fusion for adolescent idiopathic scoliosis is associated with significant pain and prolonged hospitalization. Standardizing care for posterior spinal fusion patients utilizing a multimodal approach can allow early mobilization, decreased LOS, and minimize opioid exposure and related side effects. The specific objectives of this pathway are to:

•    Standardize the care of patients undergoing posterior spinal fusion (PSF) pre-op, intra-op, post-op, and at discharge home
•    Promote early mobilization
•    Decrease length of stay
•    Minimize opioid exposure and related side effects
•    Provide access to Narcan and education of opioid overdose treatment
•    Educate of safe use/storage and disposal of medications including opioids

 

Algorithm  Educational Module

•    Length of time on opioid PCA (in hours)
•    % of patients with pathway order set utilization 
•    Length of stay (LOS)
               o   Overall LOS for all patients
               o    Breakdown of LOS by #vertebrae fused
•    Number of post-op infections
•    Average length of time(hours) 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
•    Narcan prescription and education provided
•    Medication safety/storage and disposal education provided

•    Centers for Disease Control and Prevention. (2024, July). When to offer naloxone to patients: Fact sheet. U.S. Department of Health and Human Services. https://www.cdc.gov/overdose-prevention/media/pdfs/2024/07/Fact-Sheet-When-to-Offer-Naloxone-to-Patients.pdf. 
•    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. 
•    Hadland SE, Agarwal R, Raman SR, Smith MJ, et al. Opioid Prescribing for Acute Pain Management in Children and Adolescents in Outpatient Settings: Clinical Practice Guideline. Pediatrics. 2024 Sep. 154(5):e2024068752. DOI:10.1542/peds.2024-068752.
•    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. 

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.