title: Rapid Recovery Pathway After Spinal Fusion for Idiopathic Scoliosis.
abstract: Posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) is associated with significant pain and prolonged hospitalization. There is evidence that early mobilization and multimodal analgesia can accelerate functional recovery and reduced length of stay (LOS). Using these principles, we implemented a quality improvement initiative to enable earlier functional recovery in our AIS-PSF population.
  
  
  
  We designed and implemented a standardized rapid recovery pathway (RRP) with evidence-based management recommendations for children aged 10 to 21 years undergoing PSF for AIS. Our primary outcome, functional recovery, was assessed using statistical process control charts for LOS and average daily pain scores. Our process measures were medication adherence and order set utilization. The balancing measure was 30-day readmission rate.
  
  
  
  We included 322 patients from January 1, 2011 to June 30, 2015 with 134 (42%) serving as historical controls, 104 (32%) representing our transition population, and 84 (26%) serving as our RRP population. Baseline average LOS was 5.7 days and decreased to 4 days after RRP implementation. Average daily pain scores remained stable with improvement on postoperative day 0 (3.8 vs 4.9 days) and 1 (3.8 vs 5 days) after RRP implementation. In the second quarter of 2015, gabapentin (91%) and ketorolac (95%) use became routine and order set utilization was 100%. Readmission rates did not increase as a result of this pathway.
  
  
  
  Implementation of a standardized RRP with multimodal pain management and early mobilization strategies resulted in reduced LOS without an increase in reported pain scores or readmissions.
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania muhlyw@email.chop.edu.
authors.forename: Wallis T
authors.initials: WT
authors.lastname: Muhly
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Wudbhav N
authors.initials: WN
authors.lastname: Sankar
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.
authors.forename: Kelly
authors.initials: K
authors.lastname: Ryan
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.
authors.forename: Annette
authors.initials: A
authors.lastname: Norton
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Lynne G
authors.initials: LG
authors.lastname: Maxwell
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.
authors.forename: Theresa
authors.initials: T
authors.lastname: DiMaggio
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.
authors.forename: Sharon
authors.initials: S
authors.lastname: Farrell
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.
authors.forename: Rachel
authors.initials: R
authors.lastname: Hughes
authors.affiliation: Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Alex
authors.initials: A
authors.lastname: Gornitzky
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Ron
authors.initials: R
authors.lastname: Keren
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: John J
authors.initials: JJ
authors.lastname: McCloskey
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: John M
authors.initials: JM
authors.lastname: Flynn
mesh_terms: D000293:Adolescent; D005260:Female; D006776:Hospitals, Pediatric / Q000639:trends; D006801:Humans; D008297:Male; D011182:Postoperative Care / Q000379:methods* / Q000639:trends; D020127:Recovery of Function / Q000502:physiology; D012600:Scoliosis / Q000175:diagnosis* / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods* / Q000639:trends