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

• Published in: Journal of pediatric orthopaedics Vol. 37; no. 2; pp. 92 - 97
• Main Authors: Fletcher, Nicholas D, Andras, Lindsay M, Lazarus, David E, Owen, Robert J, Geddes, Benjamin J, Cao, Jessica, Skaggs, David L, Oswald, Timothy S, Bruce, Jr, Robert W
• Format: Journal Article
• Language: English
• Published: United States 01-03-2017
• Subjects: Adolescent; Case-Control Studies; Critical Pathways; Humans; Length of Stay; Operative Time; Patient Discharge; Postoperative Complications; Retrospective Studies; Scoliosis - surgery; Spinal Fusion
• ISSN: 0271-6798; 1539-2570
• DOI: 10.1097/BPO.0000000000000601

Hospital stay after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) has decreased only modestly over time despite a healthy patient population. The purpose of this study was to evaluate the impact of a novel postoperative pathway on length of stay (LOS) and complications.
A retrospective review of patients undergoing PSF for AIS in 2011 to 2012 was performed at 2 institutions evaluating demographics, preoperative Cobb angles, surgical duration, blood loss, LOS, and postoperative complications. Patients at one center were managed using an accelerated discharge (AD) pathway emphasizing early transition to oral pain medications mobilization with physical therapy 2 to 3 times/d, and discharge regardless of return of bowel function. Expectations were set with the family before surgery for early discharge. Patients at the other center were managed without a standardized pathway.
One hundred five patients underwent PSF and were treated by an AD pathway, whereas 45 patients were managed using a traditional discharge (TD) pathway. There was no difference in proximal thoracic and main thoracic Cobb magnitudes and a small difference in thoracolumbar curve magnitudes (35.2±13.0 degrees AD vs. 40.6±11.4 degrees TD, P=0.004) between groups. Surgical time was slightly shorter in AD patients (median 3.1 vs. 3.9 h, P=0.0003) with no difference in estimated blood loss. LOS was 48% shorter in the AD group (2.2 vs. 4.2 d, P<0.0001). There was no difference in readmissions or wound complications between groups.
Hospital stay was nearly 50% shorter in patients managed by the AD pathway without any increase in readmissions or early complications.
Discharge after PSF for AIS may be expedited using a coordinated postoperative pathway. No increase in complications was seen using the AD pathway. Earlier discharge may reduce health care costs and allow an earlier return to normalcy for families.
Level III-case control study.