Clinical and economic implications of early discharge following posterior spinal fusion for adolescent idiopathic scoliosis

• Type of Material: Article
• Authors: Nicholas Fletcher, Emory University; Nader Shourbaji, Emory University; Phillip M. Mitchell, Emory University; Timothy Oswald, Emory University; Dennis P. Devito, Children’s Orthopaedic of Atlanta; Robert Bruce Jr., Emory University
• Language: English
• Date: 2014-05-01
• Publisher: Springer Verlag (Germany)
• Publication Version: Final Published Version
• Copyright Statement: © 2014, The Author(s).
• License: Creative Commons Attribution 3.0 Unported
• Final Published Version (URL): http://dx.doi.org/10.1007/s11832-014-0587-y
• Title of Journal or Parent Work: Journal of Children's Orthopaedics
• ISSN: 1863-2521
• Volume: 8
• Issue: 3
• Start Page: 257
• End Page: 263
• Keywords: Cost of treatment; Accelerated discharge; Posterior spinal fusion; Adolescent idiopathic scoliosis
• Research Categories: Health Sciences, General

Abstract

Objective: To evaluate the clinical and economic impact of a novel postoperative pathway following posterior spinal fusion (PSF) in patients with adolescent idiopathic scoliosis (AIS). Methods: Patient charts were reviewed for demographic data and to determine length of surgery, implant density, use of osteotomies, estimated blood loss, American Society of Anesthesiologists (ASA) score, length of hospital stay, and any subsequent complications. Hospital charges were divided by charge code to evaluate potential savings. Results: Two hundred and seventy-nine of 365 patients (76.4 %) treated with PSF carried a diagnosis of AIS and had completed 6 months of clinical and radiologic follow-up, a period of time deemed adequate to assess early complications. There was no difference between groups in age at surgery, sex, number of levels fused, or length of follow-up. Patients managed under the accelerated discharge (AD) pathway averaged 1.36 (31.7 %) fewer days of inpatient stay. Operative time was associated with a shorter length of stay. There was no difference in complications between groups. Hospital charges for room and board were significantly less in the AD group ($1.885 vs. $2,779, p  <  0.001). Conclusions: A pathway aimed to expedite discharge following PSF for AIS decreased hospital stay by nearly one-third without any increase in early complication rate. A small but significant decrease in hospital charges was seen following early discharge. Early discharge following PSF for AIS may be achieved without increased risk of complications, while providing a small cost savings.