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Variability in length of stay following neuromuscular spinal fusion.
- Source :
-
Spine deformity [Spine Deform] 2020 Aug; Vol. 8 (4), pp. 725-732. Date of Electronic Publication: 2020 Feb 14. - Publication Year :
- 2020
-
Abstract
- Background: Patients with neuromuscular scoliosis (NMS) who undergo posterior spinal fusion (PSF) often have long, protracted hospital stays because of numerous comorbidities. Coordinated perioperative pathways can reduce length of hospitalization (LOH) without increasing complications; however, a subset of patients may not be suited to rapid mobilization and early discharge.<br />Methods: 197 patients with NMS underwent PSF at a single hospital by two surgeons with a post-operative care pathway emphasizing early mobilization, rapid transition to enteral feeds, and discharge prior to first bowel movement. Average LOH was 4.9 days for all patients. Patients were divided into quartiles (< 3 days, 3-5 days, 5-7 days, > 7 days) based on their LOH, and their charts were retrospectively reviewed for preoperative, intraoperative, and postoperative factors associated with their LOH.<br />Results: Age at surgery, gender, the need for tube feeds, and specific underlying neuromuscular disorder were not significant predictors of LOH; however, severely involved cerebral palsy (CP) patients (GMFCS 4/5) were more likely to have extended stays than GMFCS 1-3 patients (p = 0.02). Radiographic predictors of LOH included major coronal Cobb angle (p = 0.002) and pelvic obliquity (p = 0.02). Intraoperative predictors included longer surgical times, greater numbers of levels fused and need for intraoperative or postoperative blood transfusion (p < 0.05). The need for ICU admission and development of a pulmonary complication were significantly more likely to fall into the extended LOH group (p < 0.05).<br />Conclusions: Several variables have been identified as significant predictors of LOH after PSF for NMS in the setting of a standardized discharge pathway. Patients with smaller curves and less complex surgeries were more amenable to accelerated discharge. Conversely, patients with severe CP with large curves and pelvic obliquity requiring longer surgeries with more blood loss may not be ideal candidates. These data can be used to inform providers' and families' post-operative expectations.<br />Level of Evidence: Therapeutic Level III.
- Subjects :
- Adolescent
Blood Loss, Surgical
Blood Transfusion
Cerebral Palsy
Child
Comorbidity
Female
Humans
Male
Operative Time
Postoperative Care
Postoperative Complications prevention & control
Retrospective Studies
Scoliosis diagnostic imaging
Scoliosis pathology
Enhanced Recovery After Surgery
Length of Stay
Scoliosis surgery
Spinal Fusion methods
Subjects
Details
- Language :
- English
- ISSN :
- 2212-1358
- Volume :
- 8
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Spine deformity
- Publication Type :
- Academic Journal
- Accession number :
- 32060807
- Full Text :
- https://doi.org/10.1007/s43390-020-00081-w