Abstract
Purpose
Perioperative management after adolescent idiopathic scoliosis (AIS) surgery varies extensively between surgeons and institutions. We devised a questionnaire to assess surgeon baseline characteristics, practice settings, and pain regimens to assess what factors contribute to perioperative pain protocols.
Methods
A multiple-choice questionnaire including 130 independent variables regarding baseline characteristics, practice environments, and pain regimen protocols was distributed to elicit information among surgeons performing AIS fusion surgery. Pairwise bivariate analysis between practice location, length of practice, and practice environment vs. type of post-operative analgesia was completed using two-tailed Fisher's exact test.
Results
85 respondents participated, all identified as practicing orthopedic surgeons. The largest group of respondents reported 20–40% of their total practice was dedicated to AIS (36%). Respondents were predominantly hospital-employed academic physicians (67%). The most common pain medication administered preoperatively was gabapentin (54%). Postoperative regimens were highly varied. Discharge pain regimens most commonly included short-acting opiates (89%), acetaminophen (86%), antispasmodics (59%), and NSAIDs (51%). Bivariate analysis revealed that fentanyl PCA was significantly associated with practice location (p < 0.05). Utilization of NSAIDs was significantly associated with length in training, with older physicians utilizing anti-inflammatories more regularly than younger physicians (p < 0.05).
Conclusion
This study identifies common perioperative regimens utilized in AIS surgery. Of interest, younger surgeons are less likely to prescribe NSAIDs post-operatively than surgeons who have been in practice for longer periods of time, which may represent a bias against anti-inflammatory medications in younger surgeons.
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SJG, ALM, BC, SKC, AKA, and SCR made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work; SJG, ALM, BC, SKC, AKA, and SCR drafted the work or revised it critically for important intellectual content; SJG, ALM, BC, SKC, AKA, and SCR approved the version to be published; SJG, ALM, BC, SKC, AKA, and SCR agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
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As this study involved no patient data or human or animal subjects and was an analysis of institutional pain protocols, no institutional review board approval was required. As this study involved no patient data or human or animal subjects and was an analysis of institutional pain protocols, informed consent does not apply for this study.
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Girdler, S.J., Lieber, A.M., Cho, B. et al. Perioperative pain protocols following surgery for adolescent idiopathic scoliosis: a snapshot of current treatments utilized by attending orthopedic surgeons. Spine Deform 12, 57–65 (2024). https://doi.org/10.1007/s43390-023-00741-7
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DOI: https://doi.org/10.1007/s43390-023-00741-7