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Determining the factors associated with a prolonged length of stay for adolescent idiopathic scoliosis patients undergoing posterior spinal instrumentation and fusion in a single-payer health care system: are these factors different than those in the United States?

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Abstract

Introduction

Rapid recovery pathways (RRP) for adolescent idiopathic scoliosis patients undergoing posterior spinal instrumentation and fusion (PSIF) have been shown to be successful in reducing hospital length of stay (LOS). Although the majority of patients are discharged within 3 days, some patients require longer hospital admission. Previous studies in the United States have identified predictors of prolonged LOS for this patient population. The goal of this project was to determine if these predictors are the same for Canadian scoliosis patients and to identify those features which are different under this single-payer system.

Methods

A RRP for scoliosis surgery was implemented in March 2015 at a single, tertiary referral children’s hospital in Canada. Previously identified features, along with numerous other patient factors, were collected. Spearman correlations were used to determine the factors most associated with hospital LOS and those factors were used in a multivariable regression model.

Results

A total of 161 patients were included in the analysis. Of the previously identified patient factors, only receiving a peri-operative transfusion was found to be significant (ρ = 0.24; p = 0.002). None of the other pre-identified variables were found to be significantly correlated with LOS. Variables not previously examined that were found to be significantly correlated with hospital LOS included ASA status (ρ = 0.19, p = 0.046), fusion involving both the thoracic and lumbar spine (ρ = 0.18, p = 0.025), and receiving celecoxib on post-operative day 1 (ρ = − 0.16; p = 0.038). The features that had the greatest association with LOS through multivariable regression was receiving a blood transfusion (B = 0.48; 95%CI 0.096–0.89; p = 0.017).

Conclusions

In this study, we found that many of the features found to be significantly correlated with prolonged hospital LOS in the United States are not transferable to the Canadian healthcare system. This is important for the Canadian, and other surgeons in a single-payer system, in order to identify pre-operative or immediate post-operative factors that may extend patient LOS following PSIF and plan resources accordingly.

Level of evidence

III; therapeutic.

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Authors and Affiliations

  1. Division of Orthopaedic Surgery, Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada

    Zachary DeVries, Nicholas Nucci, Kevin Smit, Andrew Tice, Jessica Romeo & James G. Jarvis

Authors
  1. Zachary DeVries
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  2. Nicholas Nucci
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  3. Kevin Smit
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  4. Andrew Tice
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  5. Jessica Romeo
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  6. James G. Jarvis
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Contributions

ZDV: conceptualization, methodology, formal analysis and investigation, writing–original draft preparation, writing–review and editing, approval of final version, accountability. NN: conceptualization, formal analysis and investigation, writing–original draft preparation, writing–review and editing, approval of final version, accountability. KS: conceptualization, methodology, writing–review and editing, approval of final version, accountability. AT: methodology, writing–review and editing, approval of final version, accountability. JR: methodology, writing–review and editing, approval of final version, accountability. JJ: conceptualization, methodology, formal analysis and investigation, writing–original draft preparation, writing–review and editing, approval of final version, accountability.

Corresponding author

Correspondence to James G. Jarvis.

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Conflict of interest

Dr Kevin Smit reports grants from Zimmer Biomet that do not involve this research project. No other conflicts to disclose.

Ethical approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Ethical Research Board of University of Ottawa approved this study.

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DeVries, Z., Nucci, N., Smit, K. et al. Determining the factors associated with a prolonged length of stay for adolescent idiopathic scoliosis patients undergoing posterior spinal instrumentation and fusion in a single-payer health care system: are these factors different than those in the United States?. Spine Deform 12, 133–139 (2024). https://doi.org/10.1007/s43390-023-00750-6

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  • DOI: https://doi.org/10.1007/s43390-023-00750-6

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