• Assem A Sultan, Ryan J Berger, William A Cantrell, Linsen T Samuel, Deepak Ramanathan, Jessica Churchill, Anas A Minkara, Joshua Golubovsky, Salam Bachour, Selena Pasadyn, Jaret M Karnuta, Pierre Tamer, Thomas E Kuivila, David P Gurd, and Ryan C Goodwin.
• Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH.
• Spine. 2019 May 15; 44 (10): 715-722.

Study DesignRetrospective cohort study.ObjectiveThe aims of this study were to (1) compare patient and procedure-specific characteristics among those who had short versus long hospital stays and (2) identify independent risk factors that may correlate with extended length of hospital stay (LOS) in patients with adolescent idiopathic scoliosis (AIS) who underwent posterior segmental instrumented fusion (PSIF).Summary Of Background DataReducing the LOS and identifying risk factors associated with extended admission have become increasingly relevant to healthcare policy makers. There is currently limited research identifying risk factors that correlate with extended stay in patients undergoing PSIF for AIS.MethodsA single-institution, longitudinally maintained database was queried to identify 407 patients who met specific inclusion and exclusion criteria. Based on the distribution and median LOS in the cohort (4 days), patients were divided into those who had long versus short LOS. In both groups, patient demographics, comorbidities, preoperative scoliosis curve measurements, surgery-related characteristics, and complications were analyzed. A univariate and multivariate regression analysis was then conducted to identify independent risk factors associated with extended LOS.ResultsPatients who had extended LOS tended to be women (84.6% vs. 75%, P = 0.01), had more levels fused (9 ± 2 vs. 7 ± 2 levels, P < 0.001), had more major postoperative complications (0.8% vs. 7.4%, P = 0.002), had more blood loss during surgery (723 ± 548 vs. 488 ± 341 cm, P < 0.001), and received less epidural analgesia for pain control (69% vs. 89%, P < 0.001). Except for higher thoracic kyphosis, long LOS patients did not have worse preoperative radiographic curve parameters. Multivariate logistic analysis identified female sex, having ≥9 ± 2 levels of fusion, operative blood loss, major postoperative complications, lack of epidural analgesia, and higher thoracic kyphosis as independent risk factors correlating for extended LOS.ConclusionIndependent risk factors identified by this study may be used to recognize patients with AIS at risk of prolonged hospital stay.Level Of Evidence3.

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