A Prospective Study on the Feasibility and Effect of an Optimized Perioperative Care Protocol in Pediatric Neuromuscular Scoliosis Surgery

Abstract

Background/Objectives: A recent retrospective study conducted by our team identified a high percentage of postoperative pneumonia in children with neuromuscular scoliosis. Based on the findings in that study and our clinical experience, we aimed to assess the effectiveness of an optimized perioperative care protocol. Methods: As part of a prospective study, a multidisciplinary team developed a protocol that included preoperative nutritional and respiratory optimization, intra- and postoperative intravenous glucose infusion, early extubation, and postoperative nutritional optimization. Non-ambulant children between 6 and 18 years of age with neuromuscular scoliosis were eligible for inclusion in the study. The primary outcome was the rate of postoperative pneumonia within 30 days of surgery. The secondary outcome measures were the rate of postoperative complications, including readmissions. All the outcomes were compared to a retrospective control group that was receiving standard care during the same period. Results: Eleven children were included in the intervention group and 14 in the control group. In regard to the intervention group, the nutritional and respiratory assessment before surgery resulted in optimized treatment in 8/11 patients (73%) and 9/11 patients (82%), respectively. One patient (9%) in the intervention group and three patients (21%) in the control group developed postoperative pneumonia (relative risk 0.42, 95% confidence interval 0.05–3.50). The intervention and control groups did not differ significantly in terms of postoperative complications or readmission rates. Conclusions: The multidisciplinary care protocol is feasible, with a high compliance rate in regard to study procedures. A numerical reduction in the 30-day pneumonia rate did occur in the intervention group; however, this reduction did not reach statistical significance.