Association Between Intravenous to Oral Opioid Transition Time and Length of Hospital Stay After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis
Transitioning from intravenous (IV) to oral opioids after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) is necessary during the postoperative course. However, few studies have assessed the effects of longer transition times on hospital length of stay (LOS). This study inves...
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Published in | International journal of spine surgery Vol. 17; no. 3; pp. 468 - 476 |
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Main Authors | , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
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International Society for the Advancement of Spine Surgery
01.06.2023
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Abstract | Transitioning from intravenous (IV) to oral opioids after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) is necessary during the postoperative course. However, few studies have assessed the effects of longer transition times on hospital length of stay (LOS). This study investigated the impact of longer IV to oral opioid transition times on LOS after PSF for AIS.
The medical records of 129 adolescents (10-18 years old) with AIS undergoing multilevel PSF at a major academic institution from 2013 to 2020 were reviewed. Patients were categorized by IV to oral opioid transition time: normal (≤2 days) vs prolonged (≥3 days). Patient demographics, comorbidities, deformity characteristics, intraoperative variables, postoperative complications, and LOS were assessed. Multivariate analyses were used to determine odds ratios for risk-adjusted extended LOS.
Of the 129 study patients, 29.5% (
= 38) had prolonged IV to oral transitions. Demographics and comorbidities were similar between the cohorts. The major curve degree (
0.762) and median (interquartile range) levels fused (
0.447) were similar between cohorts, but procedure time was significantly longer in the prolonged cohort (normal: 6.6 ± 1.2 hours vs prolonged: 7.2 ± 1.3 hours,
= 0.009). Postoperative complication rates were similar between the cohorts. Patients with prolonged transitions had significantly longer LOS (normal: 4.6 ± 1.3 days vs prolonged: 5.1 ± 0.8 days,
< 0.001) but similar discharge disposition (
= 0.722) and 30-day readmission rates (
0.99). On univariate analysis, transition time was significantly associated with extended LOS (OR: 2.0, 95% CI [0.9, 4.6],
= 0.014), but this assocation was not significant on multivariate analysis (adjusted OR: 2.1, 95% CI [1.3, 4.8],
= 0.062).
Longer postoperative IV to oral opioid transitions after PSF for AIS may have implications for hospital LOS. |
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AbstractList | Transitioning from intravenous (IV) to oral opioids after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) is necessary during the postoperative course. However, few studies have assessed the effects of longer transition times on hospital length of stay (LOS). This study investigated the impact of longer IV to oral opioid transition times on LOS after PSF for AIS.
The medical records of 129 adolescents (10-18 years old) with AIS undergoing multilevel PSF at a major academic institution from 2013 to 2020 were reviewed. Patients were categorized by IV to oral opioid transition time: normal (≤2 days) vs prolonged (≥3 days). Patient demographics, comorbidities, deformity characteristics, intraoperative variables, postoperative complications, and LOS were assessed. Multivariate analyses were used to determine odds ratios for risk-adjusted extended LOS.
Of the 129 study patients, 29.5% (
= 38) had prolonged IV to oral transitions. Demographics and comorbidities were similar between the cohorts. The major curve degree (
0.762) and median (interquartile range) levels fused (
0.447) were similar between cohorts, but procedure time was significantly longer in the prolonged cohort (normal: 6.6 ± 1.2 hours vs prolonged: 7.2 ± 1.3 hours,
= 0.009). Postoperative complication rates were similar between the cohorts. Patients with prolonged transitions had significantly longer LOS (normal: 4.6 ± 1.3 days vs prolonged: 5.1 ± 0.8 days,
< 0.001) but similar discharge disposition (
= 0.722) and 30-day readmission rates (
0.99). On univariate analysis, transition time was significantly associated with extended LOS (OR: 2.0, 95% CI [0.9, 4.6],
= 0.014), but this assocation was not significant on multivariate analysis (adjusted OR: 2.1, 95% CI [1.3, 4.8],
= 0.062).
Longer postoperative IV to oral opioid transitions after PSF for AIS may have implications for hospital LOS. BACKGROUNDTransitioning from intravenous (IV) to oral opioids after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) is necessary during the postoperative course. However, few studies have assessed the effects of longer transition times on hospital length of stay (LOS). This study investigated the impact of longer IV to oral opioid transition times on LOS after PSF for AIS.METHODSThe medical records of 129 adolescents (10-18 years old) with AIS undergoing multilevel PSF at a major academic institution from 2013 to 2020 were reviewed. Patients were categorized by IV to oral opioid transition time: normal (≤2 days) vs prolonged (≥3 days). Patient demographics, comorbidities, deformity characteristics, intraoperative variables, postoperative complications, and LOS were assessed. Multivariate analyses were used to determine odds ratios for risk-adjusted extended LOS.RESULTSOf the 129 study patients, 29.5% (n = 38) had prolonged IV to oral transitions. Demographics and comorbidities were similar between the cohorts. The major curve degree (P = 0.762) and median (interquartile range) levels fused (P = 0.447) were similar between cohorts, but procedure time was significantly longer in the prolonged cohort (normal: 6.6 ± 1.2 hours vs prolonged: 7.2 ± 1.3 hours, P = 0.009). Postoperative complication rates were similar between the cohorts. Patients with prolonged transitions had significantly longer LOS (normal: 4.6 ± 1.3 days vs prolonged: 5.1 ± 0.8 days, P < 0.001) but similar discharge disposition (P = 0.722) and 30-day readmission rates (P > 0.99). On univariate analysis, transition time was significantly associated with extended LOS (OR: 2.0, 95% CI [0.9, 4.6], P = 0.014), but this assocation was not significant on multivariate analysis (adjusted OR: 2.1, 95% CI [1.3, 4.8], P = 0.062).CONCLUSIONSLonger postoperative IV to oral opioid transitions after PSF for AIS may have implications for hospital LOS.LEVEL OF EVIDENCE: 3 |
Author | Maloy, Gwyneth David, Wyatt B Tuason, Dominick A Craft, Samuel Elsamadicy, Aladine A Fernandez, Tiana Hengartner, Astrid C Havlik, John Freedman, Isaac G DiLuna, Michael Koo, Andrew B Reeves, Benjamin C Sarkozy, Margot |
AuthorAffiliation | 2 Department of Orthopedics , Yale University School of Medicine , New Haven , CT , USA 1 Department of Neurosurgery , Yale University School of Medicine , New Haven , CT , USA 3 Department of Anesthesiology , Critical Care, and Pain Medicine, Massachusetts General Hospital , Boston , MA , USA |
AuthorAffiliation_xml | – name: 3 Department of Anesthesiology , Critical Care, and Pain Medicine, Massachusetts General Hospital , Boston , MA , USA – name: 2 Department of Orthopedics , Yale University School of Medicine , New Haven , CT , USA – name: 1 Department of Neurosurgery , Yale University School of Medicine , New Haven , CT , USA |
Author_xml | – sequence: 1 givenname: Astrid C surname: Hengartner fullname: Hengartner, Astrid C organization: Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA – sequence: 2 givenname: John surname: Havlik fullname: Havlik, John organization: Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA – sequence: 3 givenname: Wyatt B surname: David fullname: David, Wyatt B organization: Department of Orthopedics, Yale University School of Medicine, New Haven, CT, USA – sequence: 4 givenname: Benjamin C surname: Reeves fullname: Reeves, Benjamin C organization: Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA – sequence: 5 givenname: Isaac G surname: Freedman fullname: Freedman, Isaac G organization: Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA – sequence: 6 givenname: Margot surname: Sarkozy fullname: Sarkozy, Margot organization: Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA – sequence: 7 givenname: Gwyneth surname: Maloy fullname: Maloy, Gwyneth organization: Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA – sequence: 8 givenname: Tiana surname: Fernandez fullname: Fernandez, Tiana organization: Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA – sequence: 9 givenname: Samuel surname: Craft fullname: Craft, Samuel organization: Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA – sequence: 10 givenname: Andrew B surname: Koo fullname: Koo, Andrew B organization: Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA – sequence: 11 givenname: Dominick A surname: Tuason fullname: Tuason, Dominick A organization: Department of Orthopedics, Yale University School of Medicine, New Haven, CT, USA – sequence: 12 givenname: Michael surname: DiLuna fullname: DiLuna, Michael organization: Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA – sequence: 13 givenname: Aladine A surname: Elsamadicy fullname: Elsamadicy, Aladine A email: aladine.elsamadicy@yale.edu organization: Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA aladine.elsamadicy@yale.edu |
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Copyright | This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2023 ISASS. To see more or order reprints or permissions, see http://ijssurgery.com. This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2023 ISASS. To see more or order reprints or permissions, see . 2023 |
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Keywords | postoperative outcomes length of stay posterior spinal fusion spine adolescent idiopathic scoliosis opioids surgery |
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Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Declaration of Conflicting Interests: Dr. Tuason reports being a paid consultant for DePuy and OrthoPediatrics; a paid presenter or speaker for DePuy, Globus Medical, and OrthoPediatrics; and a board or committee member for the Pediatric Orthopaedic Society of North America and the Scoliosis Research Society. The remaining authors have nothing to report. IRB Approval: Protocol # 2000028261. Funding: The authors received no financial support for the research, authorship, and/or publication of this article. |
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Title | Association Between Intravenous to Oral Opioid Transition Time and Length of Hospital Stay After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis |
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