Association Between Intravenous to Oral Opioid Transition Time and Length of Hospital Stay After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis.

Autor:	Hengartner AC; Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA., Havlik J; Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA., David WB; Department of Orthopedics, Yale University School of Medicine, New Haven, CT, USA., Reeves BC; Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA., Freedman IG; Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA., Sarkozy M; Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA., Maloy G; Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA., Fernandez T; Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA., Craft S; Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA., Koo AB; Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA., Tuason DA; Department of Orthopedics, Yale University School of Medicine, New Haven, CT, USA., DiLuna M; Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA., Elsamadicy AA; Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA aladine.elsamadicy@yale.edu.
Jazyk:	angličtina
Zdroj:	International journal of spine surgery [Int J Spine Surg] 2023 Jun; Vol. 17 (3), pp. 468-476. Date of Electronic Publication: 2023 Apr 19.
DOI:	10.14444/8448
Abstrakt:	Background: 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. Methods: 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. Results: Of 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). Conclusions: Longer postoperative IV to oral opioid transitions after PSF for AIS may have implications for hospital LOS. Competing Interests: 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. (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.)
Databáze:	MEDLINE
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