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Research ArticleOther and Special Categories

Association Between Intravenous to Oral Opioid Transition Time and Length of Hospital Stay After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

Astrid C. Hengartner, John Havlik, Wyatt B. David, Benjamin C. Reeves, Isaac G. Freedman, Margot Sarkozy, Gwyneth Maloy, Tiana Fernandez, Samuel Craft, Andrew B. Koo, Dominick A. Tuason, Michael DiLuna and Aladine A. Elsamadicy
International Journal of Spine Surgery April 2023, 8448; DOI: https://doi.org/10.14444/8448
Astrid C. Hengartner
1 Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
BS
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John Havlik
1 Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
BS
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Wyatt B. David
2 Department of Orthopedics, Yale University School of Medicine, New Haven, CT, USA
MS
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Benjamin C. Reeves
1 Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
BS
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Isaac G. Freedman
3 Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
MD, MPH
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Margot Sarkozy
1 Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
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Gwyneth Maloy
1 Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
BS
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Tiana Fernandez
1 Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
BS
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Samuel Craft
1 Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
MS
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Andrew B. Koo
1 Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
MD
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Dominick A. Tuason
2 Department of Orthopedics, Yale University School of Medicine, New Haven, CT, USA
MD
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Michael DiLuna
1 Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
MD
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Aladine A. Elsamadicy
1 Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
MD
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  • For correspondence: aladine.elsamadicy@yale.edu
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    Table 1

    Patient demographics and comorbidities.

    VariablesNormal
    (n = 91)
    Prolonged
    (n = 38)
    P Value
    Age, y  0.755
     Mean ± SD14.1 ± 1.714.2 ± 2.2 
     Median (IQR)14.0 (13.0–15.0)14.0 (12.2–16.0) 
    Female, n (%)72 (79.1)28 (73.7)0.497
    Race/ethnicity   
     Non-Hispanic white62 (68.1)30 (78.9)0.286
    Body mass index (kg/m2)  0.916
     Mean ± SD22.0 ± 3.522.4 ± 5.4 
     Median (IQR)21.4 (19.4–23.5)21.2 (19.5–24.4) 
    Comorbidities, n (%)   
     Affective disorder8 (8.8)3 (7.9)>0.99
     Attention-deficit/hyperactivity disorder4 (4.4)3 (7.9)0.420
     Autism spectrum disorder4 (4.4)0 (0.0)0.319
     Congenital heart defect3 (3.3)1 (2.6)>0.99
     Asthma21 (23.1)8 (21.1)0.984
     Anemia24 (27.3)9 (25.0)0.971
     Obesity13 (14.3)7 (18.4)0.745
     Hypothyroidism2 (2.2)0 (0.0)>0.99
     Seizure disorder2 (2.2)1 (2.6)>0.99
     Gastroesophageal reflux disease2 (2.2)1 (2.6)>0.99
     Eczema6 (6.6)1 (2.6)0.673
    Number of allergies, n (%)  0.885
     052 (57.1)23 (60.5) 
     124 (26.4)10 (26.3) 
      >115 (16.5)5 (13.2) 
    Preoperative laboratory values, mean ± SD   
     Hemoglobin, g/dL13.0 ± 1.113.2 ± 1.30.572
     Hematocrit, %38.8 ± 3.239.1 ± 4.00.657
     Albumin, g/dL4.4 ± 0.24.5 ± 0.30.373
     Platelets, ×1000 µL290.0 ± 62.3298.0 ± 70.20.449
     Creatinine, mg/dL0.6 ± 0.20.6 ± 0.20.901
    • Abbreviation: IQR, interquartile range.

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    Table 2

    Deformity characteristics.

    VariablesNormal
    (n = 91)
    Prolonged
    (n = 38)
    P Value
    Major curve degree  0.762
     Mean ± SD60.9 ± 11.660.0 ± 9.8 
     Median (IQR)58.0 (52.5–64.0)57.5 (53.0–63.0) 
    Minor curve degree  0.302
     Mean ± SD43.6 ± 13.946.1 ± 11.9 
     Median (IQR)44.0 (36.0–51.0)45.5 (38.0–51.8) 
    Risser stage, n (%)  0.246
     1–232 (35.2)14 (36.8) 
     3–551 (56.0)17 (44.7) 
     Not specified8 (8.8)7 (18.4) 
    • Abbreviation: IQR, interquartile range.

    • View popup
    Table 3

    Intraoperative variables.

    VariablesNormal
    (n = 91)
    Prolonged
    (n = 38)
    P Value
    Median fusion levels (IQR)12.0 (11.0–13.0)12.0 (12.0–13.0)0.447
    Osteotomies performed, n (%)15 (16.5)5 (13.2)0.792
    Estimated blood loss, mL   
     Mean ± SD1042.0 ± 502.01087.0 ± 494.00.745
    RBC transfusion, n (%)   
     Autologous33 (36.3)12 (31.6)0.252
     Nonautologous16 (17.6)5 (13.2)0.319
    Units of RBC transfused, n (%)  0.509
     042 (46.2)14 (36.8) 
     120 (22.0)8 (21.1) 
      >129 (31.9)16 (42.1) 
    Platelets/fresh frozen plasma transfusion, n (%)4 (4.4)3 (7.9)0.420
    Cell saver, n (%)91 (100.0)37 (97.4)0.295
    Albumin transfusion, n (%)54 (59.3)27 (71.1)0.292
    Tranexamic acid used, n (%)80 (87.9)27 (71.1) 0.039
    Aminocaproic acid used, n (%)10 (11.0)9 (23.7)0.114
    Procedure time, h   0.009
     Mean ± SD6.6 ± 1.27.2 ± 1.3 
     Median (IQR)6.5 (5.9–7.4)7.0 (6.4–8.1) 
    Spinal cord injury, n (%)1 (1.1)0 (0.0)>0.99
    Durotomy, n (%)0 (0.0)1 (2.6)0.295
    Neuromonitoring changes, n (%)4 (4.4)2 (5.3)>0.99
    Plastic surgery closure, n (%)13 (14.3)5 (13.2)>0.99
    Drain use, n (%)85 (93.4)38 (100.0)0.178
    Intrathecal opioid administration, n (%)79 (86.8)31 (86.1)>0.99
    • Abbreviations: IQR, interquartile range; RBC, red blood cell.

    • Note: Bold indicates a statistically significant P value.

    • View popup
    Table 4

    Postoperative pain and PT.

    VariablesNormal
    (n = 91)
    Prolonged
    (n = 38)
    P Value
    Pain before first PT session, n (%)0.759
     None/mild (0–5)50 (54.9)18 (47.4)
     Moderate/severe (6–10)23 (25.3)11 (28.9)
     Not specified18 (19.8)9 (23.7)
    Days to ambulation0.055
     Mean ± SD2.4 ± 0.92.7 ± 0.8
     Median (interquartile range)2 (2, 3)3 (2, 3)
    Ambulation steps on first day of ambulation, mean ± SD104.0 ± 106.069.2 ± 72.00.094
    Maximum ambulation steps before discharge, mean ± SD202.0 ± 83.7188.0 ± 84.60.297
    • Abbreviation: PT, physical therapy.

    • View popup
    Table 5

    Postoperative variables.

    VariablesNormal
    (n = 91)
    Prolonged
    (n = 38)
    P Value
    Persistent tachycardia, n (%)36 (39.6)23 (60.5) 0.047
    Fever, n (%)28 (30.8)19 (50.0)0.062
    Hypotension, n (%)19 (20.9)8 (21.1)>0.99
    Hypertension, n (%)7 (7.7)3 (7.9)>0.99
    Anemia, n (%)85 (93.4)35 (92.1)0.722
    Required blood transfusion, n (%)16 (17.6)6 (15.8)>0.99
    Atelectasis, n (%)2 (2.2)4 (10.5)0.062
    Ileus, n (%)3 (3.3)0 (0.0)0.555
    Urinary retention, n (%)1 (1.1)0 (0.0)>0.99
    Postoperative laboratory values, mean ± SD
     Hemoglobin, g/dL9.8 ± 1.510.1 ± 1.30.204
     Hematocrit, %29.2 ± 4.230.0 ± 3.80.304
    Total pediatric intensive care unit length of stay, d0.076
     Mean ± SD1.4 ± 1.01.5 ± 0.6
    Total hospital length of stay, d <0.001
     Mean ± SD4.6 ± 1.35.1 ± 0.8
     Median (interquartile range)4 (4, 5)5 (5, 6)
    Discharge disposition, n (%)0.722
     Home85 (93.4)35 (92.1)
     Home with home services6 (6.6)3 (7.9)
    30-d Unplanned readmission, n (%)2 (2.2)1 (2.6)>0.99
    • Note: Bold indicates a statistically significant P value.

    • View popup
    Table 6

    Univariate and multivariate logistic regression analysis for extended hospital LOS.

    VariableUnivariate ModelMultivariate Model
    OR (95% CI) P ValueAdjusted OR (95% CI) P Value
    Age1.5 (1.1–2.1)0.3071.4 (1.1–2.0) 0.022
    Female sex3.4 (0.9–22.0)0.1166.2 (1.4–16.3) 0.034
    Days to oral pain medication only2.0 (0.9–4.6) 0.014 2.1 (1.0–4.8)0.062
    Days to ambulation2.3 (1.3–4.2) 0.006 --
    Tranexamic acid given0.2 (0.1–0.6) 0.002 --
    Aminocaproic acid given5.0 (1.7–14.6) 0.003 --
    Drain use0.0 (0.0–0.0)0.992
    Persistent tachycardia1.9 (0.7–4.9)0.172--
    Fever2.0 (0.8–5.0)0.151--
    Atelectasis2.6 (0.3–14.2)0.293--
    Procedure time, h1.7 (1.2–2.6) 0.005 1.8 (1.1–2.9) 0.015
    Ambulation steps on first day of ambulation1.0 (1.0–1.0)0.707--
    Pediatric intensive care unit LOS2.0 (1.2–3.4) 0.013 2.0 (1.2–4.1) 0.019
    • Abbreviation: LOS, length of stay.

    • Note: Bold indicates a statistically significant P value.

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International Journal of Spine Surgery: 19 (S2)
International Journal of Spine Surgery
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Association Between Intravenous to Oral Opioid Transition Time and Length of Hospital Stay After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis
Astrid C. Hengartner, John Havlik, Wyatt B. David, Benjamin C. Reeves, Isaac G. Freedman, Margot Sarkozy, Gwyneth Maloy, Tiana Fernandez, Samuel Craft, Andrew B. Koo, Dominick A. Tuason, Michael DiLuna, Aladine A. Elsamadicy
International Journal of Spine Surgery Apr 2023, 8448; DOI: 10.14444/8448

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Association Between Intravenous to Oral Opioid Transition Time and Length of Hospital Stay After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis
Astrid C. Hengartner, John Havlik, Wyatt B. David, Benjamin C. Reeves, Isaac G. Freedman, Margot Sarkozy, Gwyneth Maloy, Tiana Fernandez, Samuel Craft, Andrew B. Koo, Dominick A. Tuason, Michael DiLuna, Aladine A. Elsamadicy
International Journal of Spine Surgery Apr 2023, 8448; DOI: 10.14444/8448
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Keywords

  • adolescent idiopathic scoliosis
  • spine
  • surgery
  • opioids
  • posterior spinal fusion
  • length of stay
  • postoperative outcomes

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