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Determining the factors associated with a prolonged length of stay for adolescent idiopathic scoliosis patients undergoing posterior spinal instrumentation and fusion in a single-payer health care system: are these factors different than those in the United States? – Lumbar Fusion

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The article examines the predictors of prolonged hospital length of stay (LOS) for Canadian scoliosis patients undergoing posterior spinal instrumentation and fusion (PSIF). The study implemented a rapid recovery pathway (RRP) for scoliosis surgery and collected data on various patient factors. The results showed that receiving a peri-operative transfusion was significantly correlated with LOS. Other variables found to be significantly correlated with LOS included ASA status, fusion involving both the thoracic and lumbar spine, and receiving celecoxib on post-operative day 1. The study found that many of the features previously identified in the United States as predictors of prolonged LOS were not applicable to the Canadian healthcare system. These findings have implications for planning resources and managing patient LOS in a single-payer system like Canada

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
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Published article

S: In this study, we found that many of the features found to be significantly correlated with prolonged hospital LOS in the United States are not transferable to the Canadian healthcare system. This is important for the Canadian, and other surgeons in a single-payer system, in order to identify pre-operative or immediate post-operative factors that may extend patient LOS following PSIF and plan resources accordingly.

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Spine Deform. 2023 Sep 6. doi: 10.1007/s43390-023-00750-6. Online ahead of print.ABSTRACTINTRODUCTION: Rapid recovery pathways (RRP) for adolescent idiopathic scoliosis patients undergoing posterior spinal instrumentation and fusion (PSIF) have been shown to be successful in reducing hospital length of stay (LOS). Although the majority of patients are discharged within 3 days, some patients require longer hospital,

Spine Deform. 2023 Sep 6. doi: 10.1007/s43390-023-00750-6. Online ahead of print.

ABSTRACT

INTRODUCTION: Rapid recovery pathways (RRP) for adolescent idiopathic scoliosis patients undergoing posterior spinal instrumentation and fusion (PSIF) have been shown to be successful in reducing hospital length of stay (LOS). Although the majority of patients are discharged within 3 days, some patients require longer hospital admission. Previous studies in the United States have identified predictors of prolonged LOS for this patient population. The goal of this project was to determine if these predictors are the same for Canadian scoliosis patients and to identify those features which are different under this single-payer system.

METHODS: A RRP for scoliosis surgery was implemented in March 2015 at a single, tertiary referral children’s hospital in Canada. Previously identified features, along with numerous other patient factors, were collected. Spearman correlations were used to determine the factors most associated with hospital LOS and those factors were used in a multivariable regression model.

RESULTS: A total of 161 patients were included in the analysis. Of the previously identified patient factors, only receiving a peri-operative transfusion was found to be significant (ρ = 0.24; p = 0.002). None of the other pre-identified variables were found to be significantly correlated with LOS. Variables not previously examined that were found to be significantly correlated with hospital LOS included ASA status (ρ = 0.19, p = 0.046), fusion involving both the thoracic and lumbar spine (ρ = 0.18, p = 0.025), and receiving celecoxib on post-operative day 1 (ρ = – 0.16; p = 0.038). The features that had the greatest association with LOS through multivariable regression was receiving a blood transfusion (B = 0.48; 95%CI 0.096-0.89; p = 0.017).

S: In this study, we found that many of the features found to be significantly correlated with prolonged hospital LOS in the United States are not transferable to the Canadian healthcare system. This is important for the Canadian, and other surgeons in a single-payer system, in order to identify pre-operative or immediate post-operative factors that may extend patient LOS following PSIF and plan resources accordingly.

LEVEL OF EVIDENCE: III; therapeutic.

PMID:37672201 | DOI:10.1007/s43390-023-00750-6

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Determining the factors associated with a prolonged length of stay for adolescent idiopathic scoliosis patients undergoing posterior spinal instrumentation and fusion in a single-payer health care system: are these factors different than those in the United States?

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Spine Deform. 2023 Sep 6. doi: 10.1007/s43390-023-00750-6. Online ahead of print.ABSTRACTINTRODUCTION: Rapid recovery pathways (RRP) for adolescent idiopathic scoliosis patients undergoing posterior spinal instrumentation and fusion (PSIF) have been shown to be successful in reducing hospital length of stay (LOS). Although the majority of patients are discharged within 3 days, some patients require longer hospital

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