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Is it feasible to implement a rapid recovery pathway for adolescent idiopathic scoliosis patients undergoing posterior spinal instrumentation and fusion in a single-payer universal health care system?

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Abstract

Purpose

The purpose of this project was to determine if it is feasible to implement a rapid recovery pathway (RRP) for the surgical treatment of adolescent idiopathic scoliosis (AIS) within a single-payer universal healthcare system while simultaneously decreasing length of stay (LOS) without increasing post-operative complications.

Methods

A retrospective analysis was completed for all patients who underwent posterior spinal fusion for AIS at a tertiary children’s hospital in Canada between March 2010 and February 2019, with date of implementation of the RRP being March 1st, 2015. Patient demographic information was collected along with a variety of outcome variables including: LOS, wound complication, infection, 30-day return to the OR, 30-day emergency department visit, and 30-day hospital readmission. An interrupted time series analysis was utilized to determine if any benefits were associated with the implementation of the RRP.

Results

A total of 244 patients were identified, with 113 patients in the conventional pathway and 131 in the RRP. No significant differences in demographic features or post-operative complications were found between the two cohorts (p > 0.05). Using a robust linear time series model, LOS was found to be significantly shorter in the RRP group, with the average LOS being 5.2 [95% IQR 4.3–6.1] days in the conventional group and 3.4 [95% IQR 3.3–3.5] days in the RRP group (p < 0.05).

Conclusion

This study shows that it is possible to implement a RRP for the surgical treatment of AIS within a single-payer universal healthcare system. Use of the pathway can effectively reduce hospital LOS without increasing the risk of developing a post-operative complication. This has the upside potential to reduce healthcare and family costs.

Level of evidence

Therapeutic III.

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Funding

Dr James Jarvis received funding from the Children’s Hospital of Eastern Ontario for this project.

Author information

Authors and Affiliations

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

    Zachary DeVries, Kevin Smit, Andrew Tice & James G. Jarvis

  2. Clinical Research Unit, Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada

    Nick Barrowman

  3. Division of Anaesthesiology, Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada

    Deborah Mervitz

  4. Division of Orthopaedic Surgery, Shriners Hospitals for Children-Honolulu, 1310 Punahou Street, Honolulu, HI, 96826-1099, USA

    Paul Moroz

Authors
  1. Zachary DeVries
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  2. Nick Barrowman
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  3. Kevin Smit
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  4. Deborah Mervitz
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  5. Paul Moroz
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  6. Andrew Tice
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  7. James G. Jarvis
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Contributions

ZD: methodology, formal analysis and investigation, writing—original draft preparation, writing—review and editing, approval of final version, and accountability. NB: methodology, formal analysis and investigation, writing—review and editing, approval of final version, and accountability. KS: conceptualization, methodology, writing—review and editing, approval of final version, and accountability. DM: conceptualization, formal analysis and investigation, writing—review and editing, approval of final version, and accountability. PM: conceptualization, methodology, writing—review and editing, approval of final version, and accountability. AT: methodology, writing—review and editing, approval of final version, and accountability. JJ: conceptualization, methodology, formal analysis and investigation, writing—original draft preparation, writing—review and editing, approval of final version, and accountability.

Corresponding author

Correspondence to James G. Jarvis.

Ethics declarations

Conflict of interests

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., Barrowman, N., Smit, K. et al. Is it feasible to implement a rapid recovery pathway for adolescent idiopathic scoliosis patients undergoing posterior spinal instrumentation and fusion in a single-payer universal health care system?. Spine Deform 8, 1223–1229 (2020). https://doi.org/10.1007/s43390-020-00146-w

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  • DOI: https://doi.org/10.1007/s43390-020-00146-w

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