Enhanced Recovery After Surgery Does Not Affect Incidence of Chronic Post-Surgical Pain and Improves Postoperative Outcomes After Paediatric Spine Surgery

Enhanced recovery after surgery (ERAS) protocol has gained traction in various surgical disciplines, including pediatric spinal surgery. ERAS protocol reduces short-term post-operative opioid consumption, improves pain, and decreases length of stay without an increase in complications. However, the long-term effects of ERAS protocol after pediatric spine surgery remains unclear. This investigation sought to determine whether the implementation of ERAS pathway affected the incidence of chronic post-surgical pain after posterior spinal fusion (PSF). A retrospective, case-control study was conducted of patients undergoing PSF for adolescent idiopathic scoliosis at a tertiary pediatric center. Demographic and surgical data, and participation in individual components of ERAS pathway were recorded. Scoliosis Research Society-22 (SRS-22) questionnaire baseline values, 3- and 12-months post-operatively between patients treated with ERAS protocol and those who did not were copmared. One-hundred forty six patients met inclusion criteria. There were 67 patients in the ERAS group and 79 in the non-ERAS (NERAS) group. Both groups were matched in demographics, pre-operative Cobb angle and the number of intervertebral levels fused. Patients treated with ERAS had shorter hospital stays (3.1 ± 1.2 versus 4.9 ±2.6 days, p < 0 .001). The NERAS group had greater percentage of Cobb angle correction (75.0 ± 11.5 %) and a smaller post-operative Cobb angle (18.1 ± 9.7°) than the ERAS group (68.4 ± 11.6 %, p < 0 .001; 22.1 ± 8.7°, p=0.009 respectively). While the SRS-22r pain domain scores significantly improved from baseline to 3-months post-operatively, there were no differences in pain scores at baseline, 3- and 12-months post-operatively between ERAS and NERAS groups. Further analysis revealed only ERAS patients reported improved self-image at 12-months compared to 3-months post operatively (p=0.009). No differences in self-image were reported within the NERAS group over time (p=0.831). Additionally, regardless of time post-surgery ERAS patients had significantly better function (p=0.026). Peri-operative management through ERAS protocol does not affect pain up to 1 year after surgery. Treatment through ERAS resulted in shorter length of stay. There may be benefits in self-image and function for patients treated with ERAS long term.