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Variability in length of stay following neuromuscular spinal fusion

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Abstract

Background

Patients with neuromuscular scoliosis (NMS) who undergo posterior spinal fusion (PSF) often have long, protracted hospital stays because of numerous comorbidities. Coordinated perioperative pathways can reduce length of hospitalization (LOH) without increasing complications; however, a subset of patients may not be suited to rapid mobilization and early discharge.

Methods

197 patients with NMS underwent PSF at a single hospital by two surgeons with a post-operative care pathway emphasizing early mobilization, rapid transition to enteral feeds, and discharge prior to first bowel movement. Average LOH was 4.9 days for all patients. Patients were divided into quartiles (< 3 days, 3–5 days, 5–7 days, > 7 days) based on their LOH, and their charts were retrospectively reviewed for preoperative, intraoperative, and postoperative factors associated with their LOH.

Results

Age at surgery, gender, the need for tube feeds, and specific underlying neuromuscular disorder were not significant predictors of LOH; however, severely involved cerebral palsy (CP) patients (GMFCS 4/5) were more likely to have extended stays than GMFCS 1–3 patients (p = 0.02). Radiographic predictors of LOH included major coronal Cobb angle (p = 0.002) and pelvic obliquity (p = 0.02). Intraoperative predictors included longer surgical times, greater numbers of levels fused and need for intraoperative or postoperative blood transfusion (p < 0.05). The need for ICU admission and development of a pulmonary complication were significantly more likely to fall into the extended LOH group (p < 0.05).

Conclusions

Several variables have been identified as significant predictors of LOH after PSF for NMS in the setting of a standardized discharge pathway. Patients with smaller curves and less complex surgeries were more amenable to accelerated discharge. Conversely, patients with severe CP with large curves and pelvic obliquity requiring longer surgeries with more blood loss may not be ideal candidates. These data can be used to inform providers’ and families’ post-operative expectations.

Level of evidence

Therapeutic Level III.

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Funding

No external funding was used for this project.

Author information

Authors and Affiliations

  1. Children’s Healthcare of Atlanta, 1400 Tullie Rd, Atlanta, GA, 30329, USA

    Nicholas D. Fletcher & Robert W. Bruce Jr.

  2. American Family Children’s Hospital, 1675 Highland Ave., Madison, WI, 53792, USA

    Laura L. Bellaire

  3. Department of Orthopaedics, Vanderbilt University, Nashville, TN, USA

    Eric S. Dilbone

  4. Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA

    Laura A. Ward

Authors
  1. Nicholas D. Fletcher
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  2. Laura L. Bellaire
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  3. Eric S. Dilbone
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  4. Laura A. Ward
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  5. Robert W. Bruce Jr.
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Contributions

Dr. Fletcher was a substantial contributor to the concept design, study planning, data interpretation, revision of the manuscript, and final approval of the manuscript. Dr. Bellaire contributed to concept design, substantial contributor to the data collection, original drafting and revision of the manuscript, and gave final approval of the manuscript. Dr. Dilbone, a medical student at the time of data collection, was a substantial contributor to concept design, data collection, and manuscript revision. He gave final approval of the manuscript. Ms. Ward was a substantial contributor to statistical analysis, manuscript revision, and gave approval of the final manuscript. Dr. Bruce was a substantial contributor to concept design, study planning, and revision of the manuscript and gave final approval of the manuscript.

Corresponding author

Correspondence to Nicholas D. Fletcher.

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Conflict of interest

Dr. Fletcher is a consultant with Medtronic Spine, Nuvasive, and Orthopaediatrics; Speakers bureau for Orthopaediatrics and Zimmer/Biomet. Board member: Children’s Healthcare of Atlanta. Research support from the Harrison Foundation. Dr. Bruce, Dr. Bellaire, Dr. Dilbone, and Laura Ward have no disclosures.

Ethical approval

Institutional Review Board approval was obtained for this study at Children’s Healthcare of Atlanta.

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Fletcher, N.D., Bellaire, L.L., Dilbone, E.S. et al. Variability in length of stay following neuromuscular spinal fusion. Spine Deform 8, 725–732 (2020). https://doi.org/10.1007/s43390-020-00081-w

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  • DOI: https://doi.org/10.1007/s43390-020-00081-w

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