Factors associated with extended length of stay in patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis

Study designCross-sectional study.ObjectivesTo investigate whether certain patient, surgical, and recovery-related factors may be associated with extended LOS following posterior spinal fusion for Adolescent Idiopathic Scoliosis (AIS).Summary of background dataUnderstanding determinants of hospital length of stay (LOS) following surgical procedures is important for perioperative planning and improvements in quality of care.MethodsUsing a private insurance claims database, AIS patients ages 10-21 that underwent posterior spinal fusion from 2010 to 2016 in the United States were identified. Extended LOS was defined as >7.2 days (+1 standard deviation from the mean). Univariate and multivariate analyses were performed to identify factors associated with extended LOS. Significance was set at p<0.05.Results5864 patients met the inclusion criteria (mean age 14.42.2 years; 75% girls). Mean LOS was 4.72.5 days (median 4 days). 69% patients had 7-12 levels fused, and 25% had 13+ levels fused. On multivariate analysis, factors associated with extended LOS were: longer fusion construct (13+ levels fused) (OR 2.1, p=0.020), thoracoplasty (OR 3.8, p<0.001), and postoperative complications: wound problems (OR 13, p<0.001), respiratory problems (OR 7.9, p<0.001), urinary tract infection (OR 6.0, p<0.001), and constipation (OR 2.4, p<0.001). Postoperative ICU admission, female gender, and surgery performed on Wednesday were significant on univariate analysis but not on multivariate analysis. Extended LOS was associated with an increase of $50,494 in net hospital payments (p<0.001).Conclusion Patient, surgical and recovery factors are associated with extended LOS in AIS patients who undergo posterior spinal fusion surgery. Extended LOS significantly increases healthcare spending.Level of evidence Level III.