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Evaluation of Outcomes Before and After Implementation of a Standardized Postoperative Care Pathway in Pediatric
Kembral L Nelson1, Lindsey L Locke, Leslie N Rhodes
1Kembral L. Nelson, PharmD, Clinical Pharmacist, Nationwide Children's Hospital, Columbus, OH. Lindsey L. Locke, MSN, CPNP-BC, Pediatric Orthopedic Nurse Practitioner, Le Bonheur Children's Hospital, Memphis, TN. Leslie N. Rhodes, DNP, PPCNP-BC, Pediatric Orthopedic Nurse Practitioner, Neuromuscular Clinic; Assistant Professor, University of Tennessee Health Science Center; College of Nursing-Health Promotion and Disease Prevention; LeBonheur Children's Hospital. William A. Mabry, PharmD, MBA, Medication Safety Pharmacist, Assistant Professor, Le Bonheur Children's Hospital, Memphis, TN; and Department of Clinical Pharmacy and Translational Science, The University of Tennessee Health Science Center, Memphis, TN. Jeffrey R. Sawyer, MD, Orthopedic Surgeon, Professor, Le Bonheur Children's Hospital, Memphis, TN; and Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, Memphis, TN. William C. Warner, Jr., MD, Orthopedic Surgeon, Professor, Le Bonheur Children's Hospital, Memphis, TN; and Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, Memphis, TN. Tamekia Jones, PhD, Statistician, Associate Professor, Children's Foundation Research Institute, Memphis, TN; and Department of Pediatrics and Preventive Medicine, The University of Tennessee, Memphis, TN. David D. Spence, MD, Orthopedic Surgeon, Assistant Professor, Le Bonheur Children's Hospital, Memphis, TN; and Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, Memphis, TN. Derek M. Kelly, MD, Orthopedic Surgeon, Professor, Le Bonheur Children's Hospital, Memphis, TN; and Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, Memphis, TN.
Insights
A standardized postoperative care pathway for adolescent idiopathic scoliosis surgery significantly reduced hospital stay, pain medication use, and time to recovery. This approach improved patient outcomes without increasing complications.
Area of Science:
- Orthopedics
- Surgical Outcomes
- Patient Care Pathways
Background:
- Standardized care pathways are crucial for minimizing variability in medical treatments.
- Implementing standardized protocols can lead to improved patient outcomes and enhanced safety.
Purpose of the Study:
- To compare the effectiveness of a standardized postoperative care pathway against individual surgeon preferences.
- Evaluate the impact of standardization on patient recovery after spinal fusion.
Main Methods:
- Retrospective review of 50 patients (ages 10-21) undergoing posterior spinal fusion for adolescent idiopathic scoliosis.
- Comparison of pre-standardization (n=25) and post-standardization (n=25) patient groups.
- Exclusion of patients with specific comorbidities or postoperative complications.
Main Results:
- The post-standardization group demonstrated significantly shorter hospital stays (p = .0166).
- Key recovery metrics including time to ambulation (p < .0001) and resumption of regular diet (p < .0001) were significantly reduced.
- Patient-controlled analgesia use (p < .0001) was also significantly decreased post-standardization.
Conclusions:
- A standardized postoperative care pathway effectively shortened length of stay and accelerated patient recovery.
- The pathway led to reduced narcotic use and faster return to a regular diet.
- No increase in complications or readmissions was observed with the standardized approach.
Background:
Standardized pathways decrease variability and improve outcomes and safety.
Purpose:
The article aims to evaluate outcomes of a standardized postoperative care pathway compared with individual surgeon preference.
Methods:
A review of patients prestandardization and poststandardization was performed. Patients between the ages of 10-21 years with adolescent idiopathic scoliosis (ICD-9 code 737.30) admitted to the hospital for posterior spinal fusion (CPT code 22630) were included in the study. The prestandardization group (25 patients) was enrolled from April 1, 2010, through March 30, 2011, and the poststandardization group (25 patients) from April 1, 2014, to March 30, 2015. Exclusion criteria were renal disease, epilepsy, neurological disorder, or postoperative complications that led to change in routine care including ileus or fever greater than 102 °F. Data were analyzed using the Wilcoxon signed rank test, with significance set at p < .001.
Results:
The length of stay (p = .0166), time to ambulation (p < .0001), patient-controlled analgesia use (p < .0001), and postoperative time to resumption of regular diet (p < .0001) were all significantly decreased in the poststandardization group. There were no complications or readmissions in either group.
Conclusion:
The standardized pathway resulted in shorter length of stay, decreased narcotic use, decreased time to regular diet, and decreased time to ambulation with no increase in complication rates.
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