title: Mapping the Road to Recovery: Shorter Stays and Satisfied Patients in Posterior Spinal Fusion.
abstract: BACKGROUND
  Adolescent idiopathic scoliosis (AIS) patients undergoing posterior spinal fusion (PSF) experience variations in their hospital care, which may lead to differences in objective and patient-reported outcomes. The purpose of this study was to demonstrate that using plan of care-educating families preoperatively and standardizing some aspects of care-would decrease time to mobility and time to discharge while maintaining pain control and patient satisfaction.
  
  
  METHODS
  Chart review was conducted in 3 groups-preprotocol (December 2008 to December 2009, n=51), first protocol (December 2, 2009 to July 24, 2013, n=100), and second protocol (July 25, 2013 to June 1, 2014, n=39)-to track pain scores (0 to 10), time to regular diet, Foley catheter removal, epidural catheter removal, mobility, and discharge. Patient satisfaction surveys (0 to 10) were administered before discharge. Statistical analysis was performed using a 1-way analysis of variance test with Tukey post hoc analysis.
  
  
  RESULTS
  Average pain scores were similar in all groups. Time to sitting was significantly reduced in both first protocol (27.2±9.8 h, P=1×10) and second protocol (28.4±13.6 h, P=3×10) compared with preprotocol (40.2±15.4 h). Time to discharge was significantly lower in second protocol (84.3±27.2 h, P=0.036) compared with first protocol (98.4±27.8 h). Patient satisfaction with care was significantly higher in first protocol (9.1/10, P=2×10) and second protocol (8.6/10, P=5×10) compared with preprotocol (6.5/10).
  
  
  CONCLUSIONS
  By educating families preoperatively and standardizing portions of postoperative care in PSF for AIS, pain scores were significantly reduced while overall satisfaction remained high. Specifically, by removing the epidural and Foley catheters on postoperative day 2, time to discharge was dramatically decreased by 15 hours. The application of a multidisciplinary, evidence-driven plan of care for AIS patients undergoing PSF improves throughput and has beneficial effects on objective and patient-reported outcomes.
  
  
  METHODS
  Level III-retrospective case series.
authors.affiliation: Department of Orthopaedic Surgery, University of Michigan, Mott Children's Hospital, Ann Arbor, MI.
authors.forename: Rameshwar R
authors.initials: RR
authors.lastname: Rao
authors.forename: MaryAnn
authors.initials: M
authors.lastname: Hayes
authors.forename: Cathy
authors.initials: C
authors.lastname: Lewis
authors.forename: Robert N
authors.initials: RN
authors.lastname: Hensinger
authors.forename: Frances A
authors.initials: FA
authors.lastname: Farley
authors.forename: Ying
authors.initials: Y
authors.lastname: Li
authors.forename: Michelle S
authors.initials: MS
authors.lastname: Caird
mesh_terms: D000293:Adolescent; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D059408:Pain Management; D000071066:Patient Reported Outcome Measures; D017060:Patient Satisfaction; D011184:Postoperative Period; D012189:Retrospective Studies; D012600:Scoliosis / Q000523:psychology* / Q000601:surgery; D013123:Spinal Fusion / Q000379:methods / Q000523:psychology*; D016896:Treatment Outcome