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Introduction <p>Posterior segmental instrumented fusion (PSIF) is considered the gold standard surgical treatment for adolescent idiopathic scoliosis (AIS), as it leads to immediate deformity correction and predictable long-term outcomes. Extended inpatient length of stay (LOS) following this intervention has been associated with greater morbidity, healthcare cost, and reoperation rates. Therefore, there is a growing impetus to reduce LOS through previously described accelerated discharge protocols. However, there is a paucity of literature characterizing perioperative factors associated with extended LOS in patients undergoing PSIF for AIS.&#xa0;Additionally, it remains unclear whether postoperative patient-reported outcomes are superior in patients with shorter LOS after AIS surgery.</p> Methods <p>A single institution’s longitudinally maintained database was queried from a large academic medical center to identify patients with AIS who underwent PSIF by a single fellowship-trained pediatric spine surgeon between 2019 and 2024. Perioperative factors including age, sex, height, weight, race, ethnicity, insurance plan, language spoken at home, Risser stage, curve magnitude, training level of first assistant, intraoperative time, levels fused, navigation assistance, estimated blood loss, and Scoliosis Research Society (SRS) scores were assessed to determine potential associations with extended LOS.</p> Results <p>Of the 118 AIS patients who underwent PSIF, the mean LOS was 3.1 ± 0.8. Perioperative factors associated with longer LOS included only greater levels fused (<i>p</i> = 0.023). Longer LOS was associated with higher postoperative SRS mental health scores (<i>p</i> = 0.022), with a trend toward greater satisfaction (<i>p</i> = 0.055) and pain (<i>p</i> = 0.072) scores after adjustment for baseline values. No other perioperative factors or specific SRS domains were associated with LOS (<i>p</i> &gt; 0.05 for all).</p> Conclusion <p>Greater number of levels (more than 11 segments) fused in surgery was associated with longer length of stay for AIS patients who underwent PSIF. With growing focus on minimizing inpatient LOS duration following PSIF for AIS patients, our findings of higher postoperative patient-reported SRS scores after longer inpatient stay may warrant prospective analysis and should be further considered in the perioperative care of AIS patients.</p> Level of evidence <p>Level III.</p>

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Higher postoperative Scoliosis Research Society (SRS) scores and number of levels fused associated with extended length of stay following posterior segmental instrumented fusion for adolescent idiopathic scoliosis

  • 期刊论文

  • 发表日期：

    2025年12月11日

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  • Ally A. Yang,
  • Anthony E. Seddio,
  • Dominick A. Tuason

摘要

Introduction

Posterior segmental instrumented fusion (PSIF) is considered the gold standard surgical treatment for adolescent idiopathic scoliosis (AIS), as it leads to immediate deformity correction and predictable long-term outcomes. Extended inpatient length of stay (LOS) following this intervention has been associated with greater morbidity, healthcare cost, and reoperation rates. Therefore, there is a growing impetus to reduce LOS through previously described accelerated discharge protocols. However, there is a paucity of literature characterizing perioperative factors associated with extended LOS in patients undergoing PSIF for AIS. Additionally, it remains unclear whether postoperative patient-reported outcomes are superior in patients with shorter LOS after AIS surgery.

Methods

A single institution’s longitudinally maintained database was queried from a large academic medical center to identify patients with AIS who underwent PSIF by a single fellowship-trained pediatric spine surgeon between 2019 and 2024. Perioperative factors including age, sex, height, weight, race, ethnicity, insurance plan, language spoken at home, Risser stage, curve magnitude, training level of first assistant, intraoperative time, levels fused, navigation assistance, estimated blood loss, and Scoliosis Research Society (SRS) scores were assessed to determine potential associations with extended LOS.

Results

Of the 118 AIS patients who underwent PSIF, the mean LOS was 3.1 ± 0.8. Perioperative factors associated with longer LOS included only greater levels fused (p = 0.023). Longer LOS was associated with higher postoperative SRS mental health scores (p = 0.022), with a trend toward greater satisfaction (p = 0.055) and pain (p = 0.072) scores after adjustment for baseline values. No other perioperative factors or specific SRS domains were associated with LOS (p > 0.05 for all).

Conclusion

Greater number of levels (more than 11 segments) fused in surgery was associated with longer length of stay for AIS patients who underwent PSIF. With growing focus on minimizing inpatient LOS duration following PSIF for AIS patients, our findings of higher postoperative patient-reported SRS scores after longer inpatient stay may warrant prospective analysis and should be further considered in the perioperative care of AIS patients.

Level of evidence

Level III.