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Factors associated with extended length of stay in patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis

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Abstract

Study design

Cross-sectional study.

Objectives

To investigate whether certain patient, surgical, and recovery-related factors may be associated with extended LOS following posterior spinal fusion for Adolescent Idiopathic Scoliosis (AIS).

Summary of background data

Understanding determinants of hospital length of stay (LOS) following surgical procedures is important for perioperative planning and improvements in quality of care.

Methods

Using a private insurance claims database, AIS patients ages 10–21 that underwent posterior spinal fusion from 2010 to 2016 in the United States were identified. Extended LOS was defined as > 7.2 days (+ 1 standard deviation from the mean). Univariate and multivariate analyses were performed to identify factors associated with extended LOS. Significance was set at p < 0.05.

Results

5864 patients met the inclusion criteria (mean age 14.4 ± 2.2 years; 75% girls). Mean LOS was 4.7 ± 2.5 days (median 4 days). 69% patients had 7–12 levels fused, and 25% had 13+ levels fused. On multivariate analysis, factors associated with extended LOS were: longer fusion construct (13+ levels fused) (OR 2.1, p = 0.020), thoracoplasty (OR 3.8, p < 0.001), and postoperative complications: wound problems (OR 13, p < 0.001), respiratory problems (OR 7.9, p < 0.001), urinary tract infection (OR 6.0, p < 0.001), and constipation (OR 2.4, p < 0.001). Postoperative ICU admission, female gender, and surgery performed on Wednesday were significant on univariate analysis but not on multivariate analysis. Extended LOS was associated with an increase of $50,494 in net hospital payments (p < 0.001).

Conclusion

Patient, surgical and recovery factors are associated with extended LOS in AIS patients who undergo posterior spinal fusion surgery. Extended LOS significantly increases healthcare spending.

Level of evidence

Level III.

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References

  1. Konieczny MR, Senyurt H, Krauspe R (2013) Epidemiology of adolescent idiopathic scoliosis. J Child Orthop 7(1):3–9

    Article  Google Scholar 

  2. Kamerlink JR, Quirno M, Auerbach JD et al (2010) Hospital cost analysis of adolescent idiopathic scoliosis correction surgery in 125 consecutive cases. J Bone Jt Surg Ser A 92(5):1097–1104

    Article  Google Scholar 

  3. Daffner SD, Beimesch CF, Wang JC (2010) Geographic and demographic variability of cost and surgical treatment of idiopathic scoliosis. Spine (Phila Pa 1976) 35(11):1165–1169

    Article  Google Scholar 

  4. Marks MC, Jain A, Newton PO, Kelly MP, Lenke LG, Lonner BS et al (2018) Cost-utility analysis of operative vs. non-operative treatment of thoracic AIS. Spine (Phila Pa 1976) 44(5):1

    Google Scholar 

  5. Boylan MR, Riesgo AM, Chu A et al (2019) Costs and complications of increased length of stay following adolescent idiopathic scoliosis surgery. J Pediatr Orthop B 28(1):27–31

    Article  Google Scholar 

  6. Fletcher ND, Andras LM, Lazarus DE et al (2017) Use of a novel pathway for early discharge was associated with a 48% shorter length of stay after posterior spinal fusion for adolescent idiopathic scoliosis. J Pediatr Orthop 37(2):92–97

    Article  Google Scholar 

  7. Gornitzky AL, Flynn JM, Muhly WT et al (2016) A rapid recovery pathway for adolescent idiopathic scoliosis that improves pain control and reduces time to inpatient recovery after posterior spinal fusion. Spine Deform 4(4):288–295

    Article  Google Scholar 

  8. Vigneswaran HT, Grabel ZJ, Eberson CP et al (2015) Surgical treatment of adolescent idiopathic scoliosis in the United States from 1997 to 2012: an analysis of 20,346 patients. J Neurosurg Pediatr 16(3):322–328

    Article  Google Scholar 

  9. Archived Consumer Price Index supplemental files. U.S. Bureau of Labor Statistics [Internet]. https://www.bls.gov/cpi/tables/supplemental-files/home.htm. Cited 25 Dec 2019

  10. Peduzzi P, Concato J, Kemper E et al (1996) A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol 49(12):1373–1379

    Article  CAS  Google Scholar 

  11. Sultan AA, Berger RJ, Cantrell WA, Samuel LT, Ramanathan D, Churchill J et al (2019) Predictors of extended length of hospital stay in adolescent idiopathic scoliosis patients undergoing posterior segmental instrumented fusion: an analysis of 407 surgeries performed at a large academic center. Spine (Phila Pa 1976). 44(10):715–722

    Article  Google Scholar 

  12. Yoshihara H, Paulino C, Yoneoka D (2018) Predictors of increased hospital stay in adolescent idiopathic scoliosis patients undergoing posterior spinal fusion: analysis of national database. Spine Deform 6(3):226–230

    Article  Google Scholar 

  13. Basques BA, Bohl DD, Golinvaux NS et al (2015) Patient factors are associated with poor short-term outcomes after posterior fusion for adolescent idiopathic scoliosis. Clin Orthop Relat Res 473(1):286–294

    Article  Google Scholar 

  14. Newman JM, Szubski CR, Barsoum WK et al (2017) Day of surgery affects length of stay and charges in primary total hip and knee arthroplasty. J Arthroplast 32(1):11–15

    Article  Google Scholar 

  15. De la Garza Ramos R, Nakhla J, Echt M et al (2019) A national analysis on predictors of discharge to rehabilitation after corrective surgery for adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 44(2):118–122

    Article  Google Scholar 

  16. Lonner BS, Ren Y, Yaszay B et al (2018) Evolution of surgery for adolescent idiopathic scoliosis over 20 years. Spine (Phila Pa 1976) 43(6):402–410

    Article  Google Scholar 

  17. Cucchiaro G, Sousa T, Sanders AE et al (2016) Accelerated discharge protocol for posterior spinal fusion patients with adolescent idiopathic scoliosis decreases hospital postoperative charges 22%. Spine (Phila Pa 1976) 42(2):92–97

    Google Scholar 

  18. Oetgen ME, Martin BD, Gordish-Dressman H et al (2018) Effectiveness and sustainability of a standardized care pathway developed with use of lean process mapping for the treatment of patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis. J Bone Joint Surg Am 100(21):1864–1870

    Article  Google Scholar 

  19. Porter DA, Glotzbecker MP, Timothy Hresko M et al (2017) Deep surgical site infections following pediatric cervical spine surgery. J Pediatr Orthop 37(8):553–556

    Article  Google Scholar 

  20. Devin CJ, Chotai S, McGirt MJ et al (2018) Intrawound vancomycin decreases the risk of surgical site infection after posterior spine surgery. Spine (Phila Pa 1976) 43(1):65–71

    Article  Google Scholar 

  21. Anderson PA, Savage JW, Vaccaro AR et al (2017) Prevention of surgical site infection in spine surgery. Neurosurgery 80(3S):S114–S123

    Article  Google Scholar 

  22. Zaouter C, Kaneva P, Carli F (2009) Less urinary tract infection by earlier removal of bladder catheter in surgical patients receiving thoracic epidural analgesia. Reg Anesth Pain Med 34(6):542–548

    Article  Google Scholar 

  23. King HA, Moe JH, Bradford DS et al (1983) The selection of fusion levels in thoracic idiopathic scoliosis. J Bone Joint Surg Am 65(9):1302–1313

    Article  CAS  Google Scholar 

  24. Celestre PC, Carreon LY, Lenke LG et al (2015) Sagittal alignment 2 years after selective and non-selective thoracic fusion for Lenke 1C adolescent idiopathic scoliosis. Spine Deform 3(6):560–565

    Article  Google Scholar 

  25. Navarro SM, Ramkumar PN, Egger AC et al (2018) Evidence-based thresholds for the volume-value relationship in adolescent idiopathic scoliosis: outcomes and economies of scale. Spine Deform 6(2):156–163

    Article  Google Scholar 

  26. Lee NJ, Guzman JZ, Kim J et al (2016) A Comparative analysis among the SRS M&M, NIS, and KID databases for the adolescent idiopathic scoliosis. Spine Deform 4(6):420–424

    Article  CAS  Google Scholar 

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Funding

No funds were received in support of this work.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, JHOC 5223, Baltimore, MD, 21287, USA

    Andrew B. Harris, Caleb Gottlich, Varun Puvanesarajah, Majd Marrache, Micheal Raad, Olivia Petrusky, Richard Skolasky, Paul D. Sponseller & Amit Jain

  2. Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, MD, USA

    Dolores Njoku

Authors
  1. Andrew B. Harris
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  2. Caleb Gottlich
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  3. Varun Puvanesarajah
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  4. Majd Marrache
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  5. Micheal Raad
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  6. Olivia Petrusky
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  7. Richard Skolasky
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  8. Dolores Njoku
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  9. Paul D. Sponseller
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  10. Amit Jain
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Contributions

ABH: conception/design, data curation, formal analysis, methodology, writing/editing of the manuscript, final review and approval of the manuscript. CG: writing/editing of the manuscript, final review and approval of the manuscript. VP: writing/editing of the manuscript, final review and approval of the manuscript. MM: writing/editing of the manuscript, final review and approval of the manuscript. MR: writing/editing of the manuscript, final review and approval of the manuscript. OP: writing/editing of the manuscript, final review and approval of the manuscript. RLS: conception/design, final review and approval of the manuscript. DN: writing/editing of the manuscript, final review and approval of the manuscript. PDS: conception/design, final review and approval of the manuscript. AJ: conception/design, methodology, writing/editing of the manuscript, final review and approval of the manuscript.

Corresponding author

Correspondence to Amit Jain.

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All authors declare that they have no conflict of interest.

Ethical approval

The study was exempt from institutional review board approval.

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Harris, A.B., Gottlich, C., Puvanesarajah, V. et al. Factors associated with extended length of stay in patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis. Spine Deform 8, 187–193 (2020). https://doi.org/10.1007/s43390-019-00008-0

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  • DOI: https://doi.org/10.1007/s43390-019-00008-0

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