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Research ArticleComplications

Factors Associated With Unplanned Readmissions and Prolonged Length of Stay in Patients Undergoing Primary Fusion for Congenital Scoliosis

Ari R. Berg, John I. Shin, Andrew Leggett, Ashok Para, Dhruv Mendiratta, Neil Kaushal and Michael J. Vives
International Journal of Spine Surgery August 2024, 18 (4) 375-382; DOI: https://doi.org/10.14444/8614
Ari R. Berg
1 Department of Orthopedics, Rutgers New Jersey Medical School, Newark, NJ, USA
MD, MBA
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  • For correspondence: ari.r.berg@gmail.com
John I. Shin
1 Department of Orthopedics, Rutgers New Jersey Medical School, Newark, NJ, USA
MD
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Andrew Leggett
1 Department of Orthopedics, Rutgers New Jersey Medical School, Newark, NJ, USA
MD
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Ashok Para
1 Department of Orthopedics, Rutgers New Jersey Medical School, Newark, NJ, USA
MD
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Dhruv Mendiratta
1 Department of Orthopedics, Rutgers New Jersey Medical School, Newark, NJ, USA
BS
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Neil Kaushal
1 Department of Orthopedics, Rutgers New Jersey Medical School, Newark, NJ, USA
MD
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Michael J. Vives
1 Department of Orthopedics, Rutgers New Jersey Medical School, Newark, NJ, USA
MD
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  • Article
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    Table 1

    Demographics and comorbidities of congenital scoliosis patients who underwent posterior fusion (N = 816).

    Variables n (%)
    Age, y mean ± SD11.32 ± 4.02
    Age, y
     0–483 (10.2)
     5–9131 (16.1)
     10–14423 (51.8)
     15–19179 (21.9)
    Sex
     Women468 (57.4)
     Men348 (42.7)
    Body mass index group
     Underweight (<18.5 kg/m2)363 (44.5)
     Nonobese (18.5–29.9 kg/m2)392 (48.0)
     Obese I (30.0–34.9 kg/m2)42 (5.2)
     Obese II (35.0–39.9 kg/m2)14 (1.7)
     Obese III (≥40 kg/m2)5 (0.6)
    Nutritional support49 (6)
    Esophageal/gastric/intestinal disease98 (12.0)
    Ionotropic support during surgery8 (1.0)
    Seizure disorder35 (4.3)
    Tracheostomy13 (1.6)
    Chronic steroid use4 (0.5)
    Developmental delay189 (23.2)
    Previous cardiac surgery98 (12.0)
    Chronic lung disease58 (7.1)
    Structural central nervous system abnormality183 (22.4)
    Asthma89 (10.9)
    Oxygen support16 (2.0)
    Hematological disease20 (2.5)
    Structural pulmonary/airway abnormality91 (11.2)
    Blood transfusions within 48 h prior to surgery4 (0.5)
    American Society of Anesthesiologists Score
     1–2458 (56.1)
     >2358 (43.9)
    Fusion to pelvis61 (7.5)
    Osteotomy254 (31.1)
    Levels fused
     <7302 (37.0)
     7–12304 (37.3)
     >12210 (25.7)
    Length of stay, d4.64 ± 3.71
    Readmission43 (5.3)
    • Note: Data presented as n (%) unless otherwise indicated.

    • View popup
    Table 2

    Average postoperative length of stay for congenital scoliosis patients who underwent posterior fusion by patient factors.

    Patient FactorsLength of Stay, mean (SD)Bivariate AnalysesMultivariate Analysis
    Beta P Beta P
    Overall4.64 (3.71)
    Age, y0.02950.2232
     0–45.24 (4.71)+0.37+0.07
     5–94.30 (2.59)−0.56−0.62
     10–144.87 (4.04)refref
     15–194.07 (2.89)−0.79−0.70
    Sex0.4977
     Men4.74 (4.29)refref
     Women4.57 (3.21)−0.18
    Body mass index group0.5259
     Underweight (<18.5 kg/m2)4.85 (4.50)+0.40
     Nonobese (18.5–29.9 kg/m2)4.44 (2.77)ref
     Obese I (30.0–34.9 kg/m2)4.50 (2.36)+0.05
     Obese II (35.0–39.9 kg/m2)5.43 (6.65)+0.98
     Obese III (≥40 kg/m2)3.8 (0.84)−0.65
    Nutritional support7.47 (6.46)+3.00<0.0001+0.550.3715
    Esophageal/gastric/intestinal disease5.65 (4.70)+1.150.0039−0.130.7614
    Ionotropic support during surgery5.63 (3.20)+0.990.4513
    Seizure disorder7.14 (6.60)+2.61<0.0001+0.770.2494
    Tracheostomy11.31 (7.64)+6.77<0.0001+4.200.0001
    Chronic steroid use5.50 (2.52)+0.860.6428
    Developmental delay5.49 (4.28)+1.100.0003−0.020.9492
    Previous cardiac surgery5.58 (5.07)+1.070.0074+0.370.3676
    Chronic lung disease7.67 (7.11)+3.26<0.0001+1.830.0004
    Structural central nervous systm abnormality5.50 (4.79)+1.100.0004+0.630.0399
    Asthma5.01 (3.52)+0.410.3198
    Oxygen support10.31 (8.77)+5.78<0.0001+3.230.0008
    Hematologic disease4.20 (1.88).−0.450.5893
    Structural pulmonary/airway abnormality6.08 (5.08)+1.61<0.0001+0.130.7661
    Blood transfusions within 48 h prior to surgery5.25 (2.06)+0.610.7425
    American Society of Anesthesiologists Score<0.00010.3416
     1–24.14 (3.30)refref
     >25.28 (4.08)+1.14+0.27
    Fusion to pelvis5.92 (5.04)+1.380.0051+0.660.1762
    Osteotomy4.73 (3.64)+0.130.6407
    Levels fused0.00240.0082
     <74.34 (3.94)refref
     7–124.41 (3.22)+0.07+0.18
     >125.40 (3.91)+1.06+0.73
    • View popup
    Table 3

    Readmission rates among congenital scoliosis patients who underwent Posterior fusion by patient factors.

    Patient FactorsReadmission Rate, %Bivariate AnalysesMultivariate Analysis
    OR P OR P
    Overall5.27
    Age, y0.3313
     0–49.842.15
     5–94.580.97
     10–144.73Ref
     15–195.031.07
    Sex0.5989
     Men5.75Ref
     Women4.910.85
    Body mass index group0.16370.2145
     Underweight (<18.5 kg/m2)5.511.371.347
     Nonobese (18.5–29.9 kg/m2)4.08refref
     Obese I (30.0–34.9 kg/m2)11.93.183.217
     Obese II (35.0–39.9 kg/m2)14.293.923.815
     Obese III (≥40 kg/m2)0<0.001<0.001
    Nutritional support10.22.1810.11921.8560.2935
    Esophageal/gastric/intestinal disease6.121.20.6873
    Ionotropic support during surgery0<0.0010.99
    Seizure disorder8.571.7370.3773
    Tracheostomy7.691.510.6955
    Chronic steroid use0<0.0010.9892
    Developmental delay7.941.8440.06471.4920.2867
    Previous cardiac surgery4.080.7410.5765
    Chronic lung disease3.450.6250.5232
    Structural central nervous system abnormality6.011.2010.6107
    Asthma5.621.0790.8762
    Oxygen support12.52.650.2082
    Hematologic disease102.0470.3475
    Structural pulmonary/airway abnormality2.20.3750.18080.2210.0492
    Blood transfusions within 48 h prior to surgery256.1160.12025.7190.1588
    American Society of Anesthesiologists Score0.5009
     1–24.8ref
     >25.871.235
    Fusion to pelvis16.394.290.00023.2410.0075
    Osteotomy5.911.1970.5851
    Levels fused0.1120.9731
     <74.3refref
     7–124.280.9931.103
      >128.11.9581.051
    Length of stay >4 d, median8.962.8380.00112.4130.0103
    • View popup
    Table 4

    Reasons for readmission within 30 days.

    Reason for Readmissiona n (%)
    Total patients readmitted43 (100)
    Wound-related complications15 (34.9)
     Deep incisional SSI8
     Superficial incisional SSI1
     Organ/space SSI1
     Wound disruption5
    Gastrointestinal-related complicationb 4 (9.3)
    Seroma or hematoma formation2 (4.7)
    Failure of internal fixation2 (4.7)
    Seizure2 (4.7)
    Breakdown of cranial or spinal infusion or shunt2 (4.7)
    Pain1 (2.3)
    Dehydration1 (2.3)
    Fever1 (2.3)
    Infection, unspecified1 (2.3)
    Pleural effusion1 (2.3)
    Cervical root disorder1 (2.3)
    Allergic urticaria1 (2.3)
    Weakness1 (2.3)
    Central nervous system complication1 (2.3)
    Unspecified7 (16.3)
    • Abbreviation: SSI, surgical site infection.

    • ↵a Reasons for readmission were provided in the International Classification of Disease, Ninth and Tenth Revisions (ICD-9 and ICD-10) codes.

    • ↵b Includes nausea/vomiting (n = 1), constipation (n = 1), fecal impaction (n = 1), and ileus (n = 1).

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Factors Associated With Unplanned Readmissions and Prolonged Length of Stay in Patients Undergoing Primary Fusion for Congenital Scoliosis
Ari R. Berg, John I. Shin, Andrew Leggett, Ashok Para, Dhruv Mendiratta, Neil Kaushal, Michael J. Vives
International Journal of Spine Surgery Aug 2024, 18 (4) 375-382; DOI: 10.14444/8614

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Factors Associated With Unplanned Readmissions and Prolonged Length of Stay in Patients Undergoing Primary Fusion for Congenital Scoliosis
Ari R. Berg, John I. Shin, Andrew Leggett, Ashok Para, Dhruv Mendiratta, Neil Kaushal, Michael J. Vives
International Journal of Spine Surgery Aug 2024, 18 (4) 375-382; DOI: 10.14444/8614
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