Hybrid Perioperative Care Model for Enhanced Recovery After Surgery (ERAS) in Adolescent Idiopathic Scoliosis Patients receiving Posterior Spinal Fusion

Aims:
Posterior spinal fusion (PSF) is an ultra-major surgery for moderate-to-severe Adolescent Idiopathic Scoliosis(AIS), requiring prolonged recovery. This study examined the feasibility and effectiveness of a physiotherapy-led, hybrid prehabilitation program combined with early postoperative mobilization to promote Enhanced Recovery After Surgery(ERAS).
Methods:
This cohort study recruited moderate-to-severe AIS patients scheduled for PSF in Prince-of-Wales Hospital. Participants received a 6-week hybrid prehabilitation program consisting of physiotherapeutic-scoliosis-specific exercises, aerobic conditioning, flexibility, and strengthening training delivered through hybrid-mode of three in-person and one telehealth session arranged biweekly. This was followed by early postoperative mobilization as tolerated. Physical function was assessed before and after prehabilitation using the Six-Minute-Walk-Test, Pulmonary Function Test, McGill-Torso-Muscular-Endurance-Test-Battery and Sit-and-Reach Test. Length of hospital stay (LOS) and Cobb angles were compared between ERAS completers and traditional care group.
Results:
Results demonstrated that 29 of 32(90.6%) eligible patients completed the ERAS program. Pre-to-post prehabilitation program improvements revealed in all outcomes with statistically significant improvements in lateral torso endurance(right: 38.6s±25.9 to 51.9±26.1s,p<0.001; left: 37.6±24.4s to 48.5±21.8s,p=0.003), dorsal torso endurance(70.5±52.8s to 97.1±49.65s,p<0.001), trunk flexor endurance(101.7±67.65s to 119.4±64.14s,p=0.044), sit-and-reach(26.1±11.61cm to 28.9±9.26cm,p=0.023), popliteal angle(right: 28.28±17.02s to 22.76±15.61s,p=0.010; left: 28.97±17.55s to 23.45±14.34s,p=0.021), and FEV1(2.15±0.72L to 2.24±0.69L, p=0.025). The ERAS cohort showed a significantly reduced LOS(3.05 days shorter, p<0.001) and superior postoperative spinal correction(19.5°vs.26.0°,p=0.048) compared to traditional care.
Conclusions:
Physiotherapy-led-hybrid-multi-model prehabilitation benefited patients who undergone PSF by promoting their physical functions and fitness at preoperative stage, contributing to higher ERAS success rates, substantially reduced hospital stays, and better postoperative spinal curve correction.