Zachary DeVries1, Nick Barrowman2, Kevin Smit1, Deborah Mervitz3, Paul Moroz4, Andrew Tice1, James G Jarvis5. 1. Division of Orthopaedic Surgery, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada. 2. Clinical Research Unit, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada. 3. Division of Anaesthesiology, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada. 4. Division of Orthopaedic Surgery, Shriners Hospitals for Children-Honolulu, 1310 Punahou Street, Honolulu, HI, 96826-1099, USA. 5. Division of Orthopaedic Surgery, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada. jarvis@cheo.on.ca.
Abstract
PURPOSE: The purpose of this project was to determine if it is feasible to implement a rapid recovery pathway (RRP) for the surgical treatment of adolescent idiopathic scoliosis (AIS) within a single-payer universal healthcare system while simultaneously decreasing length of stay (LOS) without increasing post-operative complications. METHODS: A retrospective analysis was completed for all patients who underwent posterior spinal fusion for AIS at a tertiary children's hospital in Canada between March 2010 and February 2019, with date of implementation of the RRP being March 1st, 2015. Patient demographic information was collected along with a variety of outcome variables including: LOS, wound complication, infection, 30-day return to the OR, 30-day emergency department visit, and 30-day hospital readmission. An interrupted time series analysis was utilized to determine if any benefits were associated with the implementation of the RRP. RESULTS: A total of 244 patients were identified, with 113 patients in the conventional pathway and 131 in the RRP. No significant differences in demographic features or post-operative complications were found between the two cohorts (p > 0.05). Using a robust linear time series model, LOS was found to be significantly shorter in the RRP group, with the average LOS being 5.2 [95% IQR 4.3-6.1] days in the conventional group and 3.4 [95% IQR 3.3-3.5] days in the RRP group (p < 0.05). CONCLUSION: This study shows that it is possible to implement a RRP for the surgical treatment of AIS within a single-payer universal healthcare system. Use of the pathway can effectively reduce hospital LOS without increasing the risk of developing a post-operative complication. This has the upside potential to reduce healthcare and family costs. LEVEL OF EVIDENCE: Therapeutic III.
PURPOSE: The purpose of this project was to determine if it is feasible to implement a rapid recovery pathway (RRP) for the surgical treatment of adolescent idiopathic scoliosis (AIS) within a single-payer universal healthcare system while simultaneously decreasing length of stay (LOS) without increasing post-operative complications. METHODS: A retrospective analysis was completed for all patients who underwent posterior spinal fusion for AIS at a tertiary children's hospital in Canada between March 2010 and February 2019, with date of implementation of the RRP being March 1st, 2015. Patient demographic information was collected along with a variety of outcome variables including: LOS, wound complication, infection, 30-day return to the OR, 30-day emergency department visit, and 30-day hospital readmission. An interrupted time series analysis was utilized to determine if any benefits were associated with the implementation of the RRP. RESULTS: A total of 244 patients were identified, with 113 patients in the conventional pathway and 131 in the RRP. No significant differences in demographic features or post-operative complications were found between the two cohorts (p > 0.05). Using a robust linear time series model, LOS was found to be significantly shorter in the RRP group, with the average LOS being 5.2 [95% IQR 4.3-6.1] days in the conventional group and 3.4 [95% IQR 3.3-3.5] days in the RRP group (p < 0.05). CONCLUSION: This study shows that it is possible to implement a RRP for the surgical treatment of AIS within a single-payer universal healthcare system. Use of the pathway can effectively reduce hospital LOS without increasing the risk of developing a post-operative complication. This has the upside potential to reduce healthcare and family costs. LEVEL OF EVIDENCE: Therapeutic III.
Authors: Akshay D Gadiya; Jonathan E J Koch; Mohammed Shakil Patel; Masood Shafafy; Michael P Grevitt; Nasir A Quraishi Journal: Spine Deform Date: 2021-03-16