State of the art review: enhanced recovery after surgery (eras) protocols in adolescent idiopathic scoliosis.

Abstract

Enhanced Recovery After Surgery (ERAS) protocols represent a multidisciplinary, evidence-based approach to optimize perioperative care and expedite recovery for patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis (AIS). Historically, postoperative care for AIS emphasized prolonged immobility and variable practices driven largely by surgeon preference. In recent years, ERAS pathways have been developed to standardize care through preoperative education and optimization, multimodal intraoperative analgesia and blood conservation, and early postoperative mobilization with expedited transition to oral pain regimens. This review identified 24 studies describing ERAS implementation for AIS. Across the included studies, ERAS protocols consistently reduced hospital length of stay by 25-55% (mean reduction of 1.44 days), facilitated earlier mobilization, and decreased opioid consumption without compromising pain control, complication rates, or readmissions. While some studies demonstrated cost savings, others showed increased costs, with intraoperative surgeon-dependent factors such as implant density and bone graft utilization emerging as dominant cost drivers. Quality improvement strategies, including Lean process mapping and plan-do-study-act (PDSA) cycles, were commonly used to support implementation, and studies demonstrated persistent, sustainable benefits over multiple years with moderate-to-good adherence. ERAS pathways have become an integral strategy for improving perioperative care in AIS surgery, offering reliable reductions in length of stay, opioid use, and time to mobilization, though further work is needed to standardize protocols and clarify their impact on healthcare costs.