Team Integrated Enhanced Recovery (TIGER) Protocol after Adolescent Idiopathic Scoliosis Correction Lowers Direct Cost and Length of Stay While Increasing Daily Contribution Margins.

Introduction: Posterior spinal fusion (PSF) is the gold standard procedure for curve correction in Adolescent Idiopathic Scoliosis (AIS). Enhanced recovery protocols (ERPs) have been found to decrease pain and hospital length of stay (LOS) resulting in decreased total hospital charges.

Methods: We identified all adolescent idiopathic scoliosis patients treated with a posterior spinal fusion at our children's hospital between 2015-2019. Length of stay, pain scores, and hospital direct costs were calculated to determine the pathway's efficacy.

Results: Hospital LOS was reduced by 26% and post-op pain scores did not significantly change when using the Team Integrated Enhanced Recovery (TIGER) protocol (P<0.05). Total hospital costs decreased by 7.9%, daily contribution margins increased 7.9%, and daily net income increased 10.6% after TIGER protocol implementation.

Conclusion: TIGER protocol resulted in decreased hospital LOS as well as direct costs for the hospital without increasing postoperative pain scores.