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

Study design: Cross-sectional study. Objectives: To 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 data: Understanding determinants of hospital length of stay (LOS) following surgical procedures is important for perioperative planning and improvements in quality of care. Methods: Using 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. Results: 5864 patients met the inclusion criteria (mean age 14.4 ± 2.2 years; 75% girls). Mean LOS was 4.7 ± 2.5 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.