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Effects of delayed ambulation following posterior spinal fusion for adolescent idiopathic scoliosis: a single institutional study

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Abstract

Objective

Mobilizing out of bed and ambulation are key components of recovery following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). However, there remains a paucity of studies identifying risk factors associated with delayed ambulation and its impact on postoperative outcomes. The aim of this study was to investigate patient- and surgical-level risk factors associated with delayed ambulation and the ramifications of delayed ambulation on healthcare utilization for patients undergoing PSF for AIS.

Methods

The medical records of 129 adolescent (10–18 years) patients diagnosed with AIS undergoing posterior spinal fusion at a major academic institution between 2013 and 2020 were reviewed. Patients were categorized based on days from surgery to ambulation: early (≤ 1 day), intermediate (2 days), or late (≥ 3 days). Patient demographics, comorbidities, spinal deformity characteristics, intraoperative variables, postoperative complications, LOS, and unplanned readmissions were assessed. The odds ratios for risk-adjusted delayed ambulation and extended LOS were determined via multivariate stepwise logistic regressions.

Results

One Hundred and Twenty Nine patients were included in this study, of which 10.8% (n = 14) were classified as Early ambulators, 41.9% (n = 54) Intermediate ambulators, and 47.3% (n = 61) were Late ambulators. Late ambulators were significantly younger than early and intermediate ambulators (Early: 15.7 ± 1.9 years vs. Intermediate: 14.8 ± 1.7 years vs. Late: 14.1 ± 1.9 years, p = 0.010). The primary and secondary spinal curves were significantly worse among Late ambulators (p < 0.001 and p = 0.002 respectively). Fusion levels (p < 0.01), EBL (p = 0.014), and the rate of RBC transfusions (p < 0.001) increased as time to ambulation increased. Transition time from IV to oral pain medications (Early: 1.6 ± 0.8 days vs. Intermediate: 2.2 ± 0.6 days vs. Late: 2.4 ± 0.6 days, p < 0.001) and total hospital length of stay (Early: 3.9 ± 1.4 days vs. Intermediate: 4.7 ± 0.9 days vs. Late: 5.1 ± 1.2 days, p < 0.001) were longer in Late ambulators. On multivariate analysis, significant predictors of delayed ambulation included primary curve degree ≥ 70° [aOR: 5.67 (1.29‒31.97), p = 0.030] and procedure time [aOR: 1.66 (1.1‒2.59), p = 0.019].

Conclusions

Our study suggests that there may be patient- and surgical-level factors that are independently associated with late ambulation following PSF for AIS, including extent of major curve and length of operative time. Additionally, delayed ambulation has implications to length of hospital stay and postoperative complications.

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References

  1. Jada A, Mackel CE, Hwang SW et al (2017) Evaluation and management of adolescent idiopathic scoliosis: a review. Neurosurg Focus 43(4):E2. https://doi.org/10.3171/2017.7.Focus17297

    Article  PubMed  Google Scholar 

  2. Lonner BS, Ren Y, Yaszay B et al (2018) Evolution of surgery for adolescent idiopathic scoliosis over 20 years: have outcomes improved? Spine (Phila Pa 1976) 43(6):402–410. https://doi.org/10.1097/brs.0000000000002332

    Article  PubMed  Google Scholar 

  3. Elsamadicy AA, Koo AB, Kundishora AJ et al (2019) Impact of patient and hospital-level risk factors on extended length of stay following spinal fusion for adolescent idiopathic scoliosis. J Neurosurg Pediatr 24:1–7. https://doi.org/10.3171/2019.5.Peds19161

    Article  Google Scholar 

  4. Elsamadicy AA, Freedman IG, Koo AB et al (2021) The effects of pulmonary risk factors on hospital resource use after posterior spinal fusion for adolescent idiopathic scoliosis correction. World Neurosurg 149:e737–e747. https://doi.org/10.1016/j.wneu.2021.01.109

    Article  PubMed  Google Scholar 

  5. Al-Mohrej OA, Aldakhil SS, Al-Rabiah MA, Al-Rabiah AM (2020) Surgical treatment of adolescent idiopathic scoliosis: complications. Ann Med Surg (Lond) 52:19–23. https://doi.org/10.1016/j.amsu.2020.02.004

    Article  PubMed  Google Scholar 

  6. Koo AB, Elsamadicy AA, Kundishora AJ et al (2020) Geographic variation in outcomes and costs after spinal fusion for adolescent idiopathic scoliosis. World Neurosurg 136:e347–e354. https://doi.org/10.1016/j.wneu.2019.12.175

    Article  PubMed  Google Scholar 

  7. Elsamadicy AA, Freedman IG, Koo AB et al (2021) Impact of preoperative anemia on outcomes after posterior spinal fusion for adolescent idiopathic scoliosis. World Neurosurg 146:e214–e224. https://doi.org/10.1016/j.wneu.2020.10.074

    Article  PubMed  Google Scholar 

  8. Elsamadicy AA, Koo AB, Lee M et al (2019) Reduced influence of affective disorders on perioperative complication rates, length of hospital stay, and healthcare costs following spinal fusion for adolescent idiopathic scoliosis. J Neurosurg Pediatr 24(6):722–727

    Article  Google Scholar 

  9. Knight BA, Bayne AP, Zusman N, Barney N, Yang S (2020) Postoperative management factors affect urinary retention following posterior spinal fusion for adolescent idiopathic scoliosis. Spine Deform 8(4):703–709. https://doi.org/10.1007/s43390-020-00090-9

    Article  PubMed  Google Scholar 

  10. (CDC) CfDCaP. 2000 CDC growth charts. https://www.cdc.gov/growthcharts/cdc_charts.htm. Accessed 15 Feb 2022

  11. Powers JM, Sandoval C (2021). In: Donald H, Mahoney J, Lorin MI, Armsb C (eds) Approach to the child with anemia. UpToDate, Waltham

    Google Scholar 

  12. Baker RD, Greer FR, Nutrition Co (2010) Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0–3 years of age). Pediatrics 126(5):1040–1050

    Article  PubMed  Google Scholar 

  13. Zakaria HM, Bazydlo M, Schultz L et al (2020) Ambulation on postoperative day #0 is associated with decreased morbidity and adverse events after elective lumbar spine surgery: analysis from the Michigan spine surgery improvement collaborative (MSSIC). Neurosurgery 87(2):320–328. https://doi.org/10.1093/neuros/nyz501

    Article  PubMed  Google Scholar 

  14. Sugarman E, Sarwahi V, Amaral T, Wollowick A, Gambassi M, Seimon L (2013) Comparative analysis of perioperative differences between hybrid versus pedicle screw instrumentation in adolescent idiopathic scoliosis. J Spinal Disord Tech 26(3):161–166. https://doi.org/10.1097/BSD.0b013e31823b9e1b

    Article  PubMed  Google Scholar 

  15. Oe S, Yamato Y, Hasegawa T et al (2020) Association between a prognostic nutritional index less than 50 and the risk of medical complications after adult spinal deformity surgery. J Neurosurg Spine 33:1–6. https://doi.org/10.3171/2020.1.Spine191410

    Article  Google Scholar 

  16. Koucheki R, Koyle M, Ibrahim GM, Nallet J, Lebel DE (2021) Comparison of interventions and outcomes of enhanced recovery after surgery: a systematic review and meta-analysis of 2456 adolescent idiopathic scoliosis cases. Eur Spine J 30(12):3457–3472. https://doi.org/10.1007/s00586-021-06984-0

    Article  PubMed  Google Scholar 

  17. Kim E, Lee B, Cucchiaro G (2017) Perioperative surgical home: evaluation of a new protocol focused on a multidisciplinary approach to manage children undergoing posterior spinal fusion operation. Anesth Analg 125(3):812–819. https://doi.org/10.1213/ane.0000000000002030

    Article  PubMed  Google Scholar 

  18. Muhly WT, Sankar WN, Ryan K et al (2016) Rapid recovery pathway after spinal fusion for idiopathic scoliosis. Pediatrics. https://doi.org/10.1542/peds.2015-1568

    Article  PubMed  Google Scholar 

  19. Julien-Marsollier F, Michelet D, Assaker R et al (2020) Enhanced recovery after surgical correction of adolescent idiopathic scoliosis. Paediatr Anaesth 30(10):1068–1076. https://doi.org/10.1111/pan.13988

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA

    Astrid C. Hengartner, Benjamin C. Reeves, Samuel Craft, Sam Boroumand, Mona Clappier, Justice Hansen, Tiana Fernandez, Andrew B. Koo, Michael DiLuna & Aladine A. Elsamadicy

  2. Department of Orthopedics, Yale University School of Medicine, New Haven, CT, USA

    Wyatt B. David, Justice Hansen, Tiana Fernandez & Dominick A. Tuason

Authors
  1. Astrid C. Hengartner
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  2. Wyatt B. David
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  3. Benjamin C. Reeves
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  4. Samuel Craft
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  5. Sam Boroumand
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  6. Mona Clappier
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  7. Justice Hansen
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  8. Tiana Fernandez
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  9. Andrew B. Koo
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  10. Dominick A. Tuason
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  11. Michael DiLuna
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  12. Aladine A. Elsamadicy
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Contributions

ACH, WBD, BCR, SC, SB, MC, JH, TF, ABK, DAT, MD, AAE: Made substantial contributions to the conception and design of the work, acquisition, analysis, or interpretation of data; drafted the work and revised it critically for important intellectual content; approved the version to be published; and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Aladine A. Elsamadicy.

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Conflict of interest

Dr. Tuason: Depuy, A Johnson & Johnson Company: Paid Consultant, Paid presenter or speaker. Globus Medical: Paid presenter or speaker. OrthoPediatrics: Paid Consultant, Paid presenter or speaker. Pediatric Orthopaedic Society of North America: Board or Committee member. Scoliosis Research Society: Board committee member. All other authors have no other disclosures.

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IRB Protocol Approval # 2000028261.

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Hengartner, A.C., David, W.B., Reeves, B.C. et al. Effects of delayed ambulation following posterior spinal fusion for adolescent idiopathic scoliosis: a single institutional study. Spine Deform 11, 1127–1136 (2023). https://doi.org/10.1007/s43390-023-00693-y

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