Title : Improving post-operative length of stay following adolescent idiopathic scoliosis surgery through standardisation of eras protocol: A closed-loop audit
Abstract:
Aim: To reduce prolonged length of stay (LOS >6 days) in patients undergoing adolescent idiopathic scoliosis (AIS) surgery by improving consistency in post-operative care through standardised implementation of ERAS principles.
Introduction: Prolonged LOS following AIS surgery increases healthcare burden and reflects variation in recovery. Enhanced Recovery After Surgery (ERAS) protocols aim to optimise perioperative care; however, inconsistent application can limit their effectiveness. This project sought to identify modifiable factors contributing to prolonged LOS and implement a structured intervention to improve outcomes.
Methods: A Quality Improvement Project using a Plan–Do–Study–Act (PDSA) approach was undertaken. Baseline data from a retrospective audit identified key contributors to prolonged LOS, including pain control, bowel dysfunction, delayed catheter removal, and variation in ERAS use. An intervention was introduced in the form of a standardised post-operative ERAS timeline embedded into operative notes, outlining expectations for analgesia, mobilisation, diet, bowel care, and catheter removal. A second cycle involved retrospective data collection from 16/01/2026 to 03/04/2026 for AIS patients undergoing scoliosis surgery. Outcome, process, and balancing measures were assessed, with prolonged LOS defined as >6 days.
Results: In Cycle 2, 15 patients were reviewed, of which 3 surgeries were cancelled. Among completed cases, 16.6% of patients experienced prolonged LOS (6 and 10 days), representing an improvement of over 12% compared to Cycle 1 (28.8%). The patient with a 10-day stay did not have ERAS documented in the post-operative plan. Key ongoing contributors to prolonged LOS included poor engagement with physiotherapy, suboptimal pain management, and delayed Trial Without Catheter (TWOC).
Conclusion: This project demonstrates that standardising ERAS implementation through inclusion in operative notes reduces prolonged LOS following AIS surgery. The reduction from 28.8% to 16.6% highlights meaningful improvement. Retrospective data collection confirms that lack of ERAS use is associated with longer stays, while consistent application improves recovery. Ongoing challenges include physiotherapy engagement, pain control, and catheter management. Further work should focus on multidisciplinary involvement and sustaining adherence to ERAS protocols to optimise patient outcomes.
