# Positive Effects of Enhanced Recovery After Surgery (ERAS) Combined with a Dual-Attending Surgeon (DAS) Approach in Patients Operated on for Adolescent Idiopathic Scoliosis (AIS)

## TL;DR

Combining ERAS protocols with a dual-surgeon approach in scoliosis surgery reduced hospital stays, surgery time, and opioid use.

## Contribution

This study demonstrates the effectiveness of combining ERAS with a dual-attending surgeon model in AIS surgery.

## Key findings

- Hospital length of stay decreased by 1.5 days with the ERAS/DAS approach.
- Operative time was reduced by 48 minutes and opioid consumption dropped by 328 mg.
- Postoperative ICU stay was shortened by 11.5 hours.

## Abstract

Background/Objectives: Enhanced recovery after surgery (ERAS) is intended to facilitate recovery after major surgery and was implemented at our institution together with a dual-attending surgeon (DAS) approach for adolescent idiopathic scoliosis (AIS) surgery. The aim of the present study was to investigate whether this change in care influenced hospital length of stay (LOS), operative time, and opioid consumption compared to the preceding approach. Methods: This is a retrospective cohort study. A post-intervention (ERAS/DAS) group of 50 AIS patients undergoing posterior spinal fusion (PSF) surgery obtained a multimodal analgesic regimen, including intrathecal morphine, and were operated on by dual-attending surgeons. This group was compared with 50 patients in a pre-intervention (pre-ERAS/DAS) group. Results: Compared to the pre-intervention group, ERAS/DAS patients had a reduced LOS, with a mean difference of −1.5 days (95% CI [−2.0; −1.0]; p < 0.0001). Operative time was shorter, with a mean difference of −48 min (95% CI [−62; −33]; p < 0.0001). There was a reduction in the in-hospital total opioid consumption, with a mean difference of −328 mg (95% CI [−406; −250]; p < 0.0001). Additionally, the length of postoperative intensive care unit (ICU) stay was reduced, with a mean difference of −11.5 h (95% CI [−12.7; −10.3]; p < 0.0001). Conclusions: The ERAS/DAS concept implemented at our institution resulted in reductions in hospital LOS, operative time, postoperative ICU stay, and in-hospital opioid consumption. Decreasing operative time and length of stay allows more patients to receive access to crucial treatment and enables more efficient use of finite resources.