Evidence map›Paper›PMID 40131676›Full record

ArticleSpine deformity2025

Longitudinal impact of a perioperative pathway for spinal fusion in adolescent idiopathic scoliosis: a quality improvement project.

Lorena V Floccari, Michael T Bigham, Matthew Holloway, Kenzie D Lundqvist, Alexandria Rundell, Richard P Steiner, Kenneth T Bono, Todd F Ritzman

Abstract read
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In one paragraph

Article in Spine deformity, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Lorena V FloccariDepartment of Orthopedic Surgery, Akron Children's Hospital, 215 W Bowery St, Akron, OH, 44308, USA. LFloccari@akronchildrens.org.ORCID http://orcid.org/0000-0003-2977-5734
Michael T BighamDepartment of Pediatrics, Akron Children's Hospital, Akron, OH, USA.ORCID http://orcid.org/0000-0002-5085-2231
Matthew HollowayDepartment of Orthopedic Surgery, Akron Children's Hospital, 215 W Bowery St, Akron, OH, 44308, USA.ORCID https://orcid.org/0000-0002-8683-2160
Kenzie D LundqvistDepartment of Orthopedic Surgery, Akron Children's Hospital, 215 W Bowery St, Akron, OH, 44308, USA.ORCID https://orcid.org/0009-0004-8797-9916
Alexandria RundellDepartment of Orthopedic Surgery, Akron Children's Hospital, 215 W Bowery St, Akron, OH, 44308, USA.
Richard P SteinerDepartment of Orthopedic Surgery, Akron Children's Hospital, 215 W Bowery St, Akron, OH, 44308, USA.ORCID https://orcid.org/0000-0002-2369-7432
Kenneth T BonoDepartment of Orthopedic Surgery, Akron Children's Hospital, 215 W Bowery St, Akron, OH, 44308, USA.
Todd F RitzmanDepartment of Orthopedic Surgery, Akron Children's Hospital, 215 W Bowery St, Akron, OH, 44308, USA.ORCID https://orcid.org/0000-0001-6587-1905

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivePrior studies show that recovery pathway implementation after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) reduces length of stay (LOS) without increasing complications, but little is known about the sustainability and longitudinal outcomes of these initiatives. This study aimed to establish and continually improve a perioperative pathway for AIS patients undergoing PSF while tracking long-term LOS performance with iterative improvements.

methodsImplementation of the AIS care pathway at a single freestanding tertiary children's hospital was initiated in January 2016 (Phase 1) with iterative annual changes and a comprehensive update in September 2021 (Phase 2). The pathway involves preoperative optimization, standardized protocols, multi-modal pain regimen, early transition to oral pain medications, and early and frequent mobilization. Outcomes were tracked longitudinally using quality-improvement methodology, and comparisons between each group were performed.

resultsFour hundred thirty six AIS patients (86 pre-implementation, 257 Phase 1, 93 Phase 2) who underwent PSF were included. Baseline patient demographics and Cobb angles were similar. Hospital LOS decreased from 5.1 days pre-implementation to 2.3 days in a stepwise fashion corresponding with pathway modifications. Intensive care unit (ICU) admissions decreased from 100% pre-implementation to 0% during Phase 2. Perioperative order set compliance increased from 0% pre-implementation to 100%. There were no significant increases in readmissions or reoperations. Direct hospitalization costs decreased by $5854.95 per case.

conclusionsA multidisciplinary perioperative pathway for AIS patients undergoing PSF significantly reduced hospital LOS by 55% and direct costs by 11.3%. Continuous improvement and data monitoring led to sustained positive outcomes over eight years. LEVEL OF EVIDENCE: III.

Indexed as

Critical PathwaysPerioperative CareQuality ImprovementScoliosisSpinal FusionAdolescentChildFemaleHumansLength of StayLongitudinal StudiesMaleTreatment OutcomeAdolescent idiopathic scoliosisPerioperative pathwayPosterior spinal fusionQuality improvement

Identifiers

PMID40131676

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.