Elsevier

Spine Deformity

Volume 6, Issue 3, May–June 2018, Pages 226-230
Spine Deformity

Case Series
Predictors of Increased Hospital Stay in Adolescent Idiopathic Scoliosis Patients Undergoing Posterior Spinal Fusion: Analysis of National Database

https://doi.org/10.1016/j.jspd.2017.09.053Get rights and content

Abstract

Study Design

Analysis of population-based national hospital discharge data collected for the Nationwide Inpatient Sample (NIS).

Objective

To examine the predictors of increased hospital stay in adolescent idiopathic scoliosis (AIS) patients undergoing posterior spinal fusion.

Summary of Background Data

As policy makers and hospitals are increasingly looking to cut costs, length of stay (LOS) after surgery has come into focus as an area for improvement. Despite this, there is limited research about the factors contributing to increased LOS for AIS patients undergoing posterior spinal fusion.

Methods

The Nationwide Inpatient Sample was used to identify pediatric patients with idiopathic scoliosis who underwent posterior spinal fusion from 2004 to 2009, using the International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) codes. Patient demographics, surgical variables, hospital characteristics, and in-hospital outcomes were retrieved. LOS was divided into two groups (longer- and shorter-stay groups) by its average. Longer stay was defined as ≥6 days. Multivariable logistic regression analysis was performed to identify the predictors of increased LOS in AIS patients undergoing posterior spinal fusion.

Results

Significant predictors of increased LOS in posterior spinal fusion for AIS patients included increased Elixhauser Comorbidity Score, number of fused levels ≥9 vertebrae, teaching hospital status, in-hospital complications, and nonroutine disposition. Wound-related complications were the strongest predictor and patients with wound-related complications were 3.14-fold more likely to have an increased LOS compared to those without wound-related complications.

Conclusions

This study identified significant predictors of increased hospital stay in posterior spinal fusion for pediatric patients with idiopathic scoliosis and patients at higher risk of longer hospitalization can be recognized. Eventually these data are expected to help optimize LOS and cost containment.

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)

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Author disclosures: HY (none); CP (personal fees from DePuy, outside the submitted work); DY (none).

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