Patients with adolescent idiopathic scoliosis (AIS) are typically healthy and yet hospital stay after posterior spinal fusion (PSF) remains lengthy.Methods:
A review of patients undergoing PSF for AIS by four pediatric orthopaedic surgeons was performed. Patients were divided based on their surgery occurring before or after the implementation of an accelerated discharge pathway (AD). Patients treated prior to the AD pathway were managed using a less standardized traditional (TD) pathway.Results:
Four surgeons performed 99 PSF for AIS using the TD pathway and 81 PSF after implementation of the AD pathway. Length of stay was 20% shorter in patients managed under the AD pathway (3.29±0.61 days vs. 4.11±0.97 days, P<0.0001) There was no difference in age, sex, preoperative main thoracic thoracolumbar curve magnitudes between groups. There was no difference in groups with regards to the use of osteotomies, number of levels fused, or total number of screws placed. Patients managed in the AD cohort had shorter surgical times (TD 4.55±0.9 hr vs. AD 4.19±1.11 hr, P=0.02) and lower estimated blood loss (TD 688±395 cc vs. AD 453±327 cc; P<0.0001). Multivariate regression analysis revealed a 0.82 day reduction in length of stay when controlling for estimated blood loss and length of surgery. There was no statistical difference between groups with regards to any complications.Conclusions:
The use of a coordinated discharge pathway helped to reduce length of stay in patients undergoing PSF for AIS without an increase in complications. This hospital stay of 3 days represents a dramatic decrease over previously published averages.