Skip to main content

Advertisement

Log in

Factors affecting length of stay after posterior spinal fusion for adolescent idiopathic scoliosis

  • Case Series
  • Published:
Spine Deformity Aims and scope Submit manuscript

Abstract

Study design

Retrospective review of prospectively collected data.

Objective

Determine factors that influence hospital length of stay after posterior spinal fusion for adolescent idiopathic scoliosis.

Summary of background data

Standardized care pathways decrease variability in care, improve patient outcomes, and decrease cost. Specifically, global care pathway development using Lean process mapping for patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis (AIS) has been shown to lead to a significant decrease in postoperative length of stay. Assessment of variables that affect length of stay after pathway implementation may identify opportunities for additional process refinement to further decrease postoperative length of stay and improve pathway efficiency.

Methods

A standardized care pathway was implemented at our institution for all patients undergoing posterior spinal fusion for AIS. This pathway was developed using the Lean process mapping technique to create evidence-based protocols for the preoperative, operative, postoperative, and postdischarge care. Patient and care-related variables in these time periods were assessed to determine those factors that significantly affected postoperative length of stay.

Results

Preoperative factors associated with a prolonged postoperative length of stay included patient ethnicity (non-Hispanic > Hispanic, p = 0.035) and gender (female > male, p = 0.039). Significant intraoperative factors included longer surgical time (p < 0.001), increased number of fusion levels (p = 0.034), and higher volume of crystalloid administered (p = 0.011). Significant postoperative factors were higher average pain scores on the first postoperative day (p < 0.001) and higher cumulative morphine use (p < 0.001).

Conclusions

Use of a standardized care pathway for the treatment of patients with AIS can decrease postoperative length of stay. Despite a carefully designed pathway, variability persists in aspects of care that can impact length of stay, including surgical efficiency, intraoperative fluid and blood management, and postoperative pain management. Continued process improvement focused on these variables will likely further improve the effectiveness of standardized pathways for patients with AIS.

Level of evidence

Level III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Dumestre DO, Webb CE, Temple-Oberle C (2017) Improved recovery experience achieved for women undergoing implant-based breast reconstruction using an enhanced recovery after surgery model. Plast Reconstr Surg 139:550–559

    Article  CAS  Google Scholar 

  2. Raman VT, Tumin D, Uffman J et al (2017) Implementation of a perioperative surgical home protocol for pediatric patients presenting for adenoidectomy. Int J Pediatr Otorhinolaryngol 101:215–222

    Article  Google Scholar 

  3. Van Citters AD, Fahlman C, Goldmann DA et al (2014) Developing a pathway for high-value, patient-centered total joint arthroplasty. Clin Orthop Relat Res 472:1619–1635

    Article  Google Scholar 

  4. Adamina M, Kehlet H, Tomlinson GA et al (2011) Enhanced recovery pathways optimize health outcomes and resource utilization: a meta-analysis of randomized controlled trials in colorectal surgery. Surgery 149:830–840

    Article  Google Scholar 

  5. Martin CT, Pugely AJ, Gao Y et al (2014) Increasing hospital charges for adolescent idiopathic scoliosis in the United States. Spine 39:1676–1682

    Article  Google Scholar 

  6. Vigneswaran HT, Grabel ZJ, Eberson CP et al (2015) Surgical treatment of adolescent idiopathic scoliosis in the United States from 1997 to 2012: an analysis of 20,346 patients. J Neurosurg Pediatr 16:322–328

    Article  Google Scholar 

  7. Fletcher ND, Andras LM, Lazarus DE et al (2017) Use of a novel pathway for early discharge was associated with a 48% shorter length of stay after posterior spinal fusion for adolescent idiopathic scoliosis. J Pediatr Orthop 37:92–97

    Article  Google Scholar 

  8. Gornitzky AL, Flynn JM, Muhly WT, Sankar WN (2016) A rapid recovery pathway for adolescent idiopathic scoliosis that improves pain control and reduces time to inpatient recovery after posterior spinal fusion. Spine Deform 4:288–295

    Article  Google Scholar 

  9. Raudenbush BL, Gurd DP, Goodwin RC et al (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

    Article  Google Scholar 

  10. Sanders A, Andras L, Sousa T et al (2017) Accelerated discharge protocol for posterior spinal fusion (PSF) patients with adolescent idiopathic scoliosis (AIS) decreases hospital post-operative charges 22. Spine 42:92–97

    Article  Google Scholar 

  11. Thomson K, Pestieau SR, Patel JJ et al (2016) Perioperative surgical home in pediatric settings: preliminary results. Anesth Analg 123:1193–1200

    Article  Google Scholar 

  12. Tsai TC, Orav EJ, Jha AK (2015) Patient satisfaction and quality of surgical care in US hospitals. Ann Surg 261:2–8

    Article  Google Scholar 

  13. Diefenbach C, Ialenti MN, Lonner BS et al (2013) Hospital cost analysis of neuromuscular scoliosis surgery. Bull Hosp Jt Dis 2013(71):272–277

    Google Scholar 

  14. Roulin D, Donadini A, Gander S et al (2013) Cost-effectiveness of the implementation of an enhanced recovery protocol for colorectal surgery. Br J Surg 100:1108–1114

    Article  CAS  Google Scholar 

  15. Forster AJ, Stiell I, Wells G et al (2003) The effect of hospital occupancy on emergency department length of stay and patient disposition. Acad Emerg Med 10:127–133

    Article  Google Scholar 

  16. Oetgen ME, Martin BD, Gordish-Dressman H et al (2018) Effectiveness and sustainability of a standardized care pathway developed with use of lean process mapping for the treatment of patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis. J Bone Jt Surg Am 100:1864–1870

    Article  Google Scholar 

  17. von Baeyer CL, Spagrud LJ, McCormick JC et al (2009) Three new datasets supporting use of the Numerical Rating Scale (NRS-11) for children’s self-reports of pain intensity. Pain 143:223–227

    Article  Google Scholar 

  18. Gammaitoni AR, Fine P, Alvarez N et al (2003) Clinical application of opioid equianalgesic data. Clin J Pain 19:286–297

    Article  Google Scholar 

  19. Pereira J, Lawlor P, Vigano A et al (2001) Equianalgesic dose ratios for opioids: a critical review and proposals for long-term dosing. J Pain Symptom Manag 22:672–687

    Article  CAS  Google Scholar 

  20. Wright J, Bareford D, Wright C et al (2004) Day case management of sickle pain: 3 years experience in a UK sickle cell unit. Br J Haematol 126:878–880

    Article  CAS  Google Scholar 

  21. Brandstrup B, Tonnesen H, Beier-Holgersen R et al (2003) Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Ann Surg 238:641–648

    Article  Google Scholar 

  22. Sinclair S, James S, Singer M (1997) Intraoperative intravascular volume optimisation and length of hospital stay after repair of proximal femoral fracture: randomised controlled trial. BMJ 315:909–912

    Article  CAS  Google Scholar 

  23. Muhly W, McCloskey J, Feldman J et al (2017) Sustained improvement in intraoperative efficiency following implementation of a dedicated surgical team for pediatric spine fusion surgery. Perioper Care Oper Room Manag 7:12–17

    Article  Google Scholar 

  24. Ohrt-Nissen S, Bukhari N, Dragsted C et al (2017) Blood transfusion in the surgical treatment of adolescent idiopathic scoliosis—a single-center experience of patient blood management in 210 cases. Transfusion 57:1808–1817

    Article  Google Scholar 

  25. Yoshihara H, Yoneoka D (2014) Predictors of allogeneic blood transfusion in spinal fusion for pediatric patients with idiopathic scoliosis in the United States, 2004–2009. Spine 39:1860–1867

    Article  Google Scholar 

  26. Oetgen ME, Litrenta J (2017) Perioperative blood management in pediatric spine surgery. J Am Acad Orthop Surg 25:480–488

    Article  Google Scholar 

  27. Tiippana EM, Hamunen K, Kontinen VK, Kalso E (2007) Do surgical patients benefit from perioperative gabapentin/pregabalin? A systematic review of efficacy and safety. Anesth Analg 104:1545–1556 (table of contents)

    Article  CAS  Google Scholar 

  28. Rusy LM, Hainsworth KR, Nelson TJ et al (2010) Gabapentin use in pediatric spinal fusion patients: a randomized, double-blind, controlled trial. Anesth Analg 110:1393–1398

    Article  CAS  Google Scholar 

  29. Muhly WT, Sankar WN, Ryan K et al (2016) Rapid recovery pathway after spinal fusion for idiopathic scoliosis. Pediatrics 137:e2015–1568

    Article  Google Scholar 

Download references

Funding

This research was supported by the Division of Anesthesiology, Pain and Perioperative Medicine, the Division of Orthopaedic Surgery and Sports Medicine, and the hospital leadership of Children’s National Health System, Washington, DC.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Benjamin D. Martin.

Ethics declarations

Conflict of interest

BDM (none), SRP (none), JC (none), HGD (none), KT (none), MEO (none).

IRB

IRB-approved study.

Additional information

Publisher's Note

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

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Martin, B.D., Pestieau, S.R., Cronin, J. et al. Factors affecting length of stay after posterior spinal fusion for adolescent idiopathic scoliosis. Spine Deform 8, 51–56 (2020). https://doi.org/10.1007/s43390-020-00042-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s43390-020-00042-3

Keywords

Navigation