Case SeriesPredictors of Increased Hospital Stay in Adolescent Idiopathic Scoliosis Patients Undergoing Posterior Spinal Fusion: Analysis of National Database
Introduction
Health care cost is continuously increasing, and policy makers and hospitals are looking to cut costs [1]. The average cost of a single stay in the hospital is more than $4,000 in the United States and hospital length of stay (LOS) after surgery has come into focus as an area for improvement [2]. Actually, advances in surgical technique, pain management, anesthesia, and antibiotic prophylaxis have all benefited the health care system in decreasing LOS [3], [4]. Earlier and faster rehabilitation protocols have become the standard of care, which also helped decreasing LOS [3], [4].
In several elective orthopedic procedures, an average of LOS has decreased dramatically with the above-mentioned efforts. For example, LOS for a single total joint arthroplasty has decreased to current averages of 3.7 days [5], [6]. Similar to total joint arthroplasty, posterior spinal fusion surgery for adolescent idiopathic scoliosis (AIS) has been an established elective procedure for one decade. Deformity correction and fixation using pedicle screw placement are currently performed universally and, therefore, LOS should be standardized.
There are several studies that analyzed the factors of increased LOS in orthopedic surgery such as total shoulder and knee joint arthroplasty [1], [7]. However, studies are limited that have examined the predictors of increased LOS in AIS patients undergoing surgery [8]. The purpose of this study was to examine the predictors of increased LOS in posterior spinal fusion for pediatric patients with idiopathic scoliosis in the United States from 2004 to 2009 by analyzing population-based national hospital discharge data collected for the Nationwide Inpatient Sample (NIS).
Section snippets
Data source
The NIS is the largest all-payer inpatient care database in the United States and contains data from approximately 8 million hospital stays from 1,000 hospitals each year. These data comprise a 20% randomly stratified sample of all US community hospitals [9]. Every entry in the database represents a single hospitalization record. Records in the NIS database include discharge and hospital information, which were used to generate national estimates in this analysis.
Patient selection
A retrospective analysis using
Patient demographics, surgical variables, hospital characteristics, and in-hospital outcomes
Table 1 contains detailed information on patient demographics, surgical variables, hospital characteristics, and in-hospital outcomes for the shorter- and longer-stay groups in posterior spinal fusion for pediatric patients with idiopathic scoliosis. The shorter-stay group included 14,890 patients, and the longer-stay group included 8,389 patients.
Predictors of increased hospital stay
Multivariate logistic regression analysis was performed to identify independent predictors of increased hospital stay. Table 2 shows the adjusted
Discussion
Our multivariate logistic analysis demonstrated that increased Elixhauser Comorbidity Score, number of fused vertebrae ≥9, in-hospital complications, teaching hospital status, and nonroutine discharge were significant predictors of increased LOS in posterior spinal fusion for pediatric patients with idiopathic scoliosis. To our knowledge, this is the first study with large sample size that specifically analyzed predictors for longer LOS in spinal fusion for AIS patients.
With an increase in the
References (17)
- et al.
Predictors of extended length of stay after elective shoulder arthroplasty
J Shoulder Elbow Surg
(2015) - et al.
Does shortened length of hospital stay affect total knee arthroplasty rehabilitation outcomes?
J Arthroplasty
(2005) - et al.
Hospital length of stay following primary total knee arthroplasty: data from the nationwide inpatient sample database
J Arthroplasty
(2015) - et al.
Extended length of stay after surgery: complications, inefficient practice, or sick patients?
JAMA Surg
(2014) - et al.
Pre-operative patient education reduces length of stay after knee joint arthroplasty
Ann R Coll Surg Engl
(2011) - et al.
Clinical characteristics and outcomes of Medicare patients undergoing total hip arthroplasty, 1991–2008
JAMA
(2011) - et al.
The Joint Ventures Program: improving outcomes and satisfaction in joint surgery patients
J Clin Outcomes Manag
(2000) - et al.
Patient factors are associated with poor short-term outcomes after posterior fusion for adolescent idiopathic scoliosis
Clin Orthop Relat Res
(2015)
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2022, World NeurosurgeryCitation Excerpt :However, the literature remains equivocal on which regions have the greatest LOS in the United States. Although some studies suggest that LOS is longer in the South,46 other studies have shown no significant difference between regions.47 Most patients in the study were treated in the South.
Multimodal analgesia and postsurgical pain
2021, Features and Assessments of Pain, Anesthesia, and AnalgesiaGeographic Variation in Outcomes and Costs After Spinal Fusion for Adolescent Idiopathic Scoliosis
2020, World NeurosurgeryCitation Excerpt :Only a few studies have explored differences in LOS after spinal fusion for AIS correction. In a retrospective analysis of 23,279 posterior spinal fusion AIS patients stratified into short and long LOS cohorts, Yoshihara et al21 found in a multivariable regression adjusting for other demographic variables that there were no significant differences in regions between the 2 LOS cohorts. Likewise, in a retrospective cohort study of 16,992 AIS cases investigating variation in care and cost of spinal fusion conducted by Workman et al,16 the authors found that LOS did not significantly differ between the different regions (West, Midwest, Northeast, and South).
Enhanced recovery after surgery in pediatric orthopedics (ERAS-PO)
2020, Orthopaedics and Traumatology: Surgery and ResearchCitation Excerpt :minimal intensive care, thanks to reduced blood loss by every means available: Cell-Saver®, controlled hypotension and tranexamic acid. So far as possible, morphine derivatives and locoregional anesthesia are eschewed, as paresis hinders early mobilization [16,17]. The protocol can be revised after analysis of the first patients.
Author disclosures: HY (none); CP (personal fees from DePuy, outside the submitted work); DY (none).