Early and late hospital readmissions in adolescent idiopathic scoliosis

Abstract

Study design

Retrospective review of a prospectively collected multicenter database.

Objectives

To identify risk factors for early and late readmission of surgically treated patients with adolescent idiopathic scoliosis (AIS).

Summary of background data

Specific risk factors associated with readmission in patients with AIS remain poorly understood.

Methods

Patients with AIS who were operatively treated from 19 centers specializing in the treatment of pediatric spinal deformity were studied. Data from a minimum 2 years of clinical follow-up and any readmission were available for analysis. Characteristics of patients with no readmission, early readmission (< 90 days), and late readmission (> 90 days) were evaluated. Both univariate and multivariate analyses of risk factors for readmission were performed.

Results

2049 patients were included in our cohort, with 1.6% requiring early readmission and 3.3% late readmission. In the multivariate analysis, greater preoperative coronal imbalance was associated with early readmission. Longer operative time was associated with late readmission. Finally, greater preoperative pain (SRS-22 pain scale) was associated with both early and late readmission. GI complications accounted for a higher proportion of early readmissions than previously reported in the literature.

Conclusions

Preoperative counseling of patients with higher levels of pain and coronal imbalance and the implementation of a thorough postoperative bowel regimen may help optimize patient outcomes.

Level of evidence

3.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    Orszag PR, Emanuel EJ (2010) Health care reform and cost control. N Engl J Med 363:601–603

    Google Scholar 

  2. 2.

    Adogwa O, Elsamadicy AA, Han JL, Karikari IO, Cheng J, Bagley CA (2017) 30-Day readmission after spine surgery: an analysis of 1400 consecutive spine surgery patients. Spine (Phila Pa 1976) 42:520–524

    Google Scholar 

  3. 3.

    Jencks SF, Williams MV, Coleman EA (2009) Rehospitalizations among patients in the medicare fee-for-service program. N Engl J Med 360:1418–1428

    Google Scholar 

  4. 4.

    Van Walraven C, Bennett C, Jennings A, Austin PC, Forster AJ (2011) Proportion of hospital readmissions deemed avoidable: a systematic review. CMAJ 183:E391-402

    Google Scholar 

  5. 5.

    Abu-Bonsrah N, Goodwin CR, Ortega G, Abdullah F, Cornwell E, De La Garza-Ramos R, Groves ML, Ain M, Sponseller PD, Sciubba DM (2017) Risk factors associated with short-term complications and mortality after pediatric spinal arthrodesis. Neurosurg Focus 43:E7

    Google Scholar 

  6. 6.

    Divecha HM, Siddique I, Breakwell LM, Millner PA (2014) Complications in spinal deformity surgery in the United Kingdom: 5-year results of the Annual British Scoliosis Society National Audit of Morbidity and Mortality. Eur Spine J 23(Suppl 1):S55-60

    Google Scholar 

  7. 7.

    Weiss HR, Goodall D (2008) Rate of complications in scoliosis surgery—a systematic review of the pubmed literature. Scoliosis 3:9

    Google Scholar 

  8. 8.

    Roddy E, Diab M (2017) Rates and risk factors associated with unplanned hospital readmission after fusion for pediatric spinal deformity. Spine J 17:369–379

    Google Scholar 

  9. 9.

    Jain A, Puvanesarajah V, Menga EN, Sponseller PD (2015) Unplanned hospital readmissions and reoperations after pediatric spinal fusion surgery. Spine (Phila Pa 1976) 40:856–862

    Google Scholar 

  10. 10.

    Minhas SV, Chow I, Feldman DS, Bosco J, Otsuka NY (2016) A predictive risk index for 30-day readmissions following surgical treatment of pediatric scoliosis. J Pediatr Orthop 36:187–192

    Google Scholar 

  11. 11.

    Carreon LY, Puno RM, Lenke LG, Richards BS, Sucato DJ, Emans JB, Erickson MA (2007) Non-neurologic complications following surgery for adolescent idiopathic scoliosis. J Bone Joint Surg Am 89:2427–2432

    Google Scholar 

  12. 12.

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

    Google Scholar 

  13. 13.

    Sanders AE, Andras LM, Sousa T, Kissinger C, Cucchiaro G, Skaggs DL (2017) Accelerated discharge protocol for posterior spinal fusion patients with adolescent idiopathic scoliosis decreases hospital postoperative charges 22%. Spine (Phila Pa) 42:92–97

    Google Scholar 

  14. 14.

    Muhly WT, Sankar WN, Ryan K, Norton A, Maxwell LG, Dimaggio T, Farrell S, Hughes R, Gornitzky A, Keren R, Mccloskey JJ, Flynn JM (2016) Rapid recovery pathway after spinal fusion for idiopathic scoliosis. Pediatrics 137:e20151568

    Google Scholar 

  15. 15.

    Jennings JK, Doyle JS, Gilbert SR, Conklin MJ, Khoury JG (2015) The use of chewing gum postoperatively in pediatric scoliosis patients facilitates an earlier return to normal bowel function. Spine Deform 3:263–266

    Google Scholar 

  16. 16.

    Biank V, Werlin S (2006) Superior mesenteric artery syndrome in children: a 20-Year experience. J Pediatr Gastroenterol Nutr 42:522–525

    Google Scholar 

  17. 17.

    Raudenbush BL, Gurd DP, Goodwin RC, Kuivila TE, Ballock RT (2017) Cost analysis of adolescent idiopathic scoliosis surgery: early discharge decreases hospital costs much less than intraoperative variables under the control of the surgeon. J Spine Surg 3:50–57

    Google Scholar 

  18. 18.

    Newton PO, Bastrom TP, Yaszay B (2017) Patient-specific risk adjustment improves comparison of infection rates following posterior fusion for adolescent idiopathic scoliosis. J Bone Joint Surg Am 99:1846–1850

    Google Scholar 

  19. 19.

    Chidambaran V, Ding L, Moore DL, Spruance K, Cudilo EM, Pilipenko V, Hossain M, Sturm P, Kashikar-Zuck S, Martin LJ, Sadhasivam S (2017) Predicting the pain continuum after adolescent idiopathic scoliosis surgery: a prospective cohort study. Eur J Pain 21:1252–1265

    Google Scholar 

  20. 20.

    Connelly M, Fulmer RD, Prohaska J, Anson L, Dryer L, Thomas V, Ariagno JE, Price N, Schwend R (2014) Predictors of postoperative pain trajectories in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 39:E174-181

    Google Scholar 

  21. 21.

    Hwang SW, Pendleton C, Samdani AF, Bastrom TP, Keeny H, Lonner BS, Newton PO, Pahys JM, Harms Study Group (2020) Preoperative SRS pain score is the primary predictor of postoperative pain after surgery for adolescent idiopathic scoliosis: an observational retrospective study of pain outcomes from a registry of 1744 patients with a mean follow-up of 3.4 years. Eur Spine J 29:754–760

    Google Scholar 

  22. 22.

    Hwang SW, Pahys JM, Bastrom TP, Lonner BS, Newton PO, Samdani AF (2019) Lower SRS mental health scores are associated with greater preoperative pain in patients with adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 44:1647–1652

    Google Scholar 

Download references

Acknowledgements

This study was supported in part by grants to the Setting Scoliosis Straight Foundation in support of Harms Study Group research from DePuy Synthes Spine, EOS Imaging, K2M, Medtronic, NuVasive and Zimmer Biomet. The members of the Harms Study Group: Aaron Buckland MD, New York University; Amer Samdani MD, Shriners Hospitals for Children—Philadelphia; Amit Jain MD, Johns Hopkins Hospital; Baron Lonner MD, Mount Sinai Hospital; Benjamin Roye MD, Columbia University; Burt Yaszay MD, Rady Children’s Hospital; Chris Reilly MD, BC Children’s Hospital; Daniel Hedequist MD, Boston Children’s Hospital; Daniel Sucato MD, Texas Scottish Rite Hospital; David Clements MD, Cooper Bone & Joint Institute New Jersey; Firoz Miyanji MD, BC Children’s Hospital; Harry Shufflebarger MD, Nicklaus Children's Hospital; Jack Flynn MD, Children’s Hospital of Philadelphia; Jahangir Asghar MD, Cantor Spine Institute; Jean Marc Mac-Thiong MD, CHU Sainte-Justine; Joshua Pahys MD, Shriners Hospitals for Children—Philadelphia; Juergen Harms MD, Klinikum Karlsbad-Langensteinbach, Karlsbad; Keith Bachmann MD, University of Virginia; Larry Lenke MD, Columbia University; Mark Abel MD, University of Virginia; Michael Glotzbecker MD, Boston Children’s Hospital; Michael Kelly MD, Washington University; Michael Vitale MD, Columbia University; Michelle Marks, PT MA, Setting Scoliosis Straight Foundation; Munish Gupta MD, Washington University; Nicholas Fletcher MD, Emory University; Patrick Cahill MD, Children’s Hospital of Philadelphia; Paul Sponseller MD, Johns Hopkins Hospital; Peter Gabos MD, Nemours/Alfred I. duPont Hospital for Children; Peter Newton MD, Rady Children’s Hospital; Peter Sturm MD, Cincinnati Children’s Hospital; Randal Betz MD, Institute for Spine & Scoliosis; Ron Lehman MD, Columbia University; Stefan Parent MD, CHU Sainte-Justine; Stephen George MD, Nicklaus Children's Hospital; Steven Hwang MD, Shriners Hospitals for Children—Philadelphia; Suken Shah MD, Nemours/Alfred I. duPont Hospital for Children; Tom Errico MD, Nicklaus Children's Hospital; Vidyadhar Upasani MD, Rady Children’s Hospital.

Funding

This study was supported in part by grants to the Setting Scoliosis Straight Foundation in support of Harms Study Group research from DePuy Synthes Spine, EOS Imaging, K2M, Medtronic, NuVasive and Zimmer Biomet.

Author information

Affiliations

Authors

Consortia

Contributions

Conceptualization: AFS, SWH; Data curation: TPB, HSG; Funding acquisition: HSG; Investigation: SWH; Methodology: AFS, SWH; Project administration: PON, HSG; Resources: HSG; Software: HSG; Supervision: AFS, PON, SAS, FM; Writing—original draft: AP, SWH; Writing—review and editing: AP, JMP, AFS, PON, TPB, SAS, FM, HSG, SWH; Final approval of submission: AP, JMP, AFS, PON, TPB, SAS, FM, HSG, SWH.

Corresponding author

Correspondence to Steven W. Hwang.

Ethics declarations

Ethical approval

This study was approved by the institutional review board at each participating institution, and the consent of the patients or their guardians was obtained.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The members of the Harms Study Group are listed in acknowledgements.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Patel, A., Pahys, J.M., Samdani, A.F. et al. Early and late hospital readmissions in adolescent idiopathic scoliosis. Spine Deform (2021). https://doi.org/10.1007/s43390-021-00294-7

Download citation

Keywords

  • Adolescent idiopathic scoliosis
  • Readmission
  • Complications