O2075: Are Rapid Recovery Protocol Reported Patient and Cost-Savings Outcomes Sustained Years Later?

Background: In previous years we have studied the effects of our Rapid Recovery Protocol (RRP) that utilizes an intraoperative intrathecal morphine (ITM) injection on the overall costs of a posterior spinal fusion surgery and patient management/outcomes. We saw that RRP patients had a shorter length of stay (LOS) and a less costly overall hospital stay. The goal of this study is to investigate if these results have been sustained.

Methods: 501 patients with adolescent idiopathic scoliosis (AIS) who underwent a posterior spinal fusion (PSF) between the years 2014-2023 were included. Patients were stratified based upon year of surgery. The Pre-RRP group consisted of patients who had their surgery prior to 2018, the year our institution implemented RRP. Group I contained patients from the first two years of RRP (2018-2019), Group II was the next two years after that (2020-2021), and the two most recent years (2022-2023) made up Group III. Results were reported as median and quartile ranges. Kruskal-Wallis tests were used for continuous variables.

Results: There were 250 patients included in the Pre-RRP group from the years 2014-2017. Group I had 105 patients, Group II had 81 patients, and in Group III there were 65 patients. As we had previously reported, LOS significantly decreased once RRP was instrumented, Pre-RRP to Group I (5.0 vs. 3.0 days, p< 0.001). Group II (2020-2021) LOS had increased to a median of 4.0 (4.0, 5.0) days. In Group III, the most recent years, the median LOS was 4.0 (3.0, 5.0) days (p < 0.001). Pre-RRP had a median hospital stay cost of $41000. Group I, the first few years of RRP, had a median of $24600, Group II had a median of $32800, and Group III had a median of $28700 (p < 0.001).

Conclusion: The improvement in outcomes seen in the first few years that RRP was implemented were not sustained in the following years. Over time, individuals tend to become less observant and lack strict adherence to protocols. Our close monitoring of RRP allowed us to recognize a decline in progress and subsequently strengthen the protocol to begin improvement of outcomes once again. It is vital to re-evaluate the outcomes of these protocols as there are not only patient benefits but cost-savings as well.

Protocols should continuously be monitored and re-enforced. Through close monitoring, our institution was able to recognize a decline in progress and subsequently strengthened the protocol to begin improvement of outcomes once again.