Rapid Discharge Protocol Reduces Length of Stay and Eliminates Postoperative Nausea and Vomiting After Surgery for Adolescent Idiopathic Scoliosis.

ABSTRACT

BACKGROUND: Implementing standardized pathways following adolescent idiopathic scoliosis surgery have been shown to reduce length of stay (LOS). However, controversies still exist. This applies especially to the transition to solid foods, postoperative pruritus, and postoperative nausea and vomiting (PONV). The aim of this proposed protocol is to present an option to reduce these factors while reducing the LOS. METHODS: The protocol was designed with reduction of morphine. One-hundred and eight patients were included in this study, including 66 controls before intervention. All patients underwent posterior scoliosis surgery. All patients were scored daily using a numeric rating scale, and they noted if any nausea, vomiting, or pruritus was present. All medications were recorded. For every 20 patients included, the steering committee met to identify any implementation issues. RESULTS: LOS was reduced from 6.3 to 3.6 days (43% reduction, P = 0.003). PONV was reduced from affecting 82% to 9% of patients (P < 0.0001). The number of patients experiencing postoperative pruritus was reduced from 40% to 2% (P < 0.001). Time spent in postoperative recovery was reduced from 278 (117 - 470) minutes to 199 (128 - 643), P < 0.001. Patients' pain scores remained unchanged compared with controls (mean 4 [3 - 8]). We found no adverse effects of solid food intake from postoperative day 0. CONCLUSIONS: We found a significant reduction in length of stay, PONV, and pruritus after implementation of the protocol. This allowed for no restrictions in regards to solid food intake postoperatively.