دورية أكاديمية
أعرض في EDS

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?

التفاصيل البيبلوغرافية
العنوان: 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?
المؤلفون: DeVries Z; Division of Orthopaedic Surgery, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada., Nucci N; Division of Orthopaedic Surgery, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada., Smit K; Division of Orthopaedic Surgery, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada., Tice A; Division of Orthopaedic Surgery, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada., Romeo J; Division of Orthopaedic Surgery, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada., Jarvis JG; Division of Orthopaedic Surgery, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada. jarvis@cheo.on.ca.
المصدر: Spine deformity [Spine Deform] 2024 Jan; Vol. 12 (1), pp. 133-139. Date of Electronic Publication: 2023 Sep 06.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Springer Nature Country of Publication: England NLM ID: 101603979 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2212-1358 (Electronic) Linking ISSN: 2212134X NLM ISO Abbreviation: Spine Deform Subsets: MEDLINE
أسماء مطبوعة: Publication: 2020- : London : Springer Nature
Original Publication: New York, N.Y. : Elsevier
مواضيع طبية MeSH: Scoliosis*/surgery , Scoliosis*/epidemiology , Kyphosis*, Child ; Humans ; Adolescent ; United States ; Length of Stay ; Single-Payer System ; Canada ; Delivery of Health Care
مستخلص: 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).
Conclusions: 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.
(© 2023. The Author(s), under exclusive licence to Scoliosis Research Society.)
References: DeVries Z, Barrowman N, Smit K et al (2020) Is it feasible to implement a rapid recovery pathway for adolescent idiopathic scoliosis patients undergoing posterior spinal instrumentation and fusion in a single-payer universal healthcare system? Spine Deform 8(6):1223–1229. (PMID: 10.1007/s43390-020-00146-w32488767)
Gornitzky AL, Flynn JM, Muhly WT et al (2016) A rapid recovery pathway for adolescent idiopathic scoliosis that improves pain control and reduces time to inpatient recovery after posterior spinal fusion. Spine Deform 4:288–295. (PMID: 10.1016/j.jspd.2016.01.00127927519)
Muhly W, Sankar WN, Ryan K et al (2016) Rapid recovery pathway after spinal fusion for idiopathic scoliosis. Pediatrics 137(4):e1–e9. (PMID: 10.1542/peds.2015-1568)
Oetgen ME, Martin BD, Gordish-Dressman H et al (2018) Effectiveness and sustainability of a standardized care pathway developed with use of lean process mapping for the treatment of patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis. J Bone Jt Surg 100:1864–1870. (PMID: 10.2106/JBJS.18.00079)
Sanders AE, Andras LM, Sousa T et al (2016) Accelerated discharge protocol for posterior spinal fusion patients with adolescent idiopathic scoliosis decreases hospital postoperative charges 22%. Spine Deform 42(2):92–97. (PMID: 10.1097/BRS.0000000000001666)
Canadian Institute for Health Information (2016) Care in Canadian ICUs. CIHI, Ottawa.
Boylan MR, Riesgo AM, Chu A et al (2019) Costs and complications of increased length of stay following adolescent idiopathic scoliosis surgery. J Pediatr Orthopaed 28(1):27–31. (PMID: 10.1097/BPB.0000000000000543)
Elsamadicy AA, Koo AB, Kundishora AJ et al (2019) Impact of patient and hospital-level risk factors on extended length of stay following spinal fusion for adolescent idiopathic scoliosis. J Neurosurg Pediatr 24:469–475. (PMID: 10.3171/2019.5.PEDS19161)
Martin BD, Pestieau SR, Cronin J et al (2020) Factors effecting length of hospital stay after posterior spinal fusion for adolescent idiopathic scoliosis. Spine Deform 8:51–56. (PMID: 10.1007/s43390-020-00042-331960355)
Harris AB, Gottlich C, Puvanesrajah V et al (2020) Factors associated with extended length of stay in patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis. Spine Deformity 8:187–193. (PMID: 10.1007/s43390-019-00008-031925765)
Sultan AA, Berger RJ, Cantrell WA et al (2018) Predictors of extended length of hospital stay in adolescent idiopathic scoliosis patients undergoing posterior segmental instrumented fusion. Spine Deform 44(10):715–722. (PMID: 10.1097/BRS.0000000000002919)
Yoshihara H, Paulino C, Yoneoka D (2018) Predictors of increased hospital length of stay in adolescent idiopathic scoliosis patients undergoing posterior spinal fusion: analysis of national database. Spine Deform 6:226–230. (PMID: 10.1016/j.jspd.2017.09.05329735130)
Hart A, Bergeron SG, Epure L et al (2016) Comparison of US and Canadian perioperative outcomes and hospital efficiency after total hip and knee arthroplasty. JAMA Surg 150(10):990–998. (PMID: 10.1001/jamasurg.2015.1239)
Pestieau S, Cronin J, Trad NK et al (2020) Implementation of a perioperative surgical home model for adolescent idiopathic scoliosis and its impact on acute pain and length of stay. J Clin Anesth 65:1–3. (PMID: 10.1016/j.jclinane.2020.109832)
Fletcher ND, Andras LM, Lazarus DE et al (2017) 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. J Pediatr Orthop 37(2):92–97. (PMID: 10.1097/BPO.000000000000060126214327)
Nelson KL, Locke LL, Rhodes LN et al (2020) Evaluation of outcomes before and after implementation of a standardized postoperative care pathway in pediatric posterior spinal fusion patients. Orthop Nurs 39(4):257–263. (PMID: 10.1097/NOR.000000000000067832701784)
Kim HJ, Park HS, Jang MJ et al (2018) Predicting massive transfusion in adolescent idiopathic scoliosis patients undergoing corrective surgery: association of preoperative radiographic findings. Medicine 97(22):1–6. (PMID: 10.1097/MD.0000000000010972)
Mange TR, Sucato DJ, Poppino KF et al (2020) The incidence and risk factors for perioperative blood transfusion in primary idiopathic scoliosis. Spine Deform 8:695–702. (PMID: 10.1007/s43390-020-00093-632152964)
Stranton R, Grauer J, L RV, Reutebuch K, et al (2021) Value in Scoliosis: Coordinated surgical and anesthetic techniques avoid blood transfusion without fibrinolytic medications and red blood cell salvage. Spine 46(17):1160–1164. (PMID: 10.1097/BRS.0000000000004026)
McVey MJ, Lau W, Narraine N et al (2021) Perioperative blood conservation strategies for pediatric scoliosis surgery. Spine Deform 9:1289–1302. (PMID: 10.1007/s43390-021-00351-133900586)
Ohrt-Nissen S, Bukhari N, Dragsted C et al (2017) Blood transfusion in the surgical treatment of adolescent idiopathic scoliosis: a single centre experience of patient blood management in 210 cases. Transfusion 57:1808–1817. (PMID: 10.1111/trf.1413728500653)
Abouleish AE, Leib ML, Cohen NH (2015) ASA provides examples to each ASA physical status class. ASA Newsl 79:38–49.
Schober P, Boer C, Schwarte LA (2018) Correlation coefficients: appropriate use and interpretation. Anesthe Analg 126(5):1763–1768. (PMID: 10.1213/ANE.0000000000002864)
فهرسة مساهمة: Keywords: Length of stay; Predictors; Rapid recovery pathway; Scoliosis
تواريخ الأحداث: Date Created: 20230906 Date Completed: 20240108 Latest Revision: 20240201
رمز التحديث: 20240201
DOI: 10.1007/s43390-023-00750-6
PMID: 37672201
قاعدة البيانات: MEDLINE
الوصف
تدمد:2212-1358
DOI:10.1007/s43390-023-00750-6