Abstract
BACKGROUND CONTEXT Posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) is a complex procedure for which charges can exceed $150,000. Among the total costs, inpatient and intensive unit care contributed 22%. Many institutions have implemented rapid recovery pathways (RRP) to improve patient care following scoliosis surgery. This study aims to determine the effects of a multimodal RRP, utilizing intrathecal morphine (ITM) in combination with oral pain medication, on hospital costs and patient management. PURPOSE The purpose of this study was to determine whether a protocol that excludes postoperative patient care analgesia (PCA) with the utilization of preoperative/intraoperative ITM had similar or superior outcomes, including hospital costs. STUDY DESIGN/SETTING Retrospective review. PATIENT SAMPLE AIS patients undergoing PSF from 2013 – 2019. OUTCOME MEASURES Hospital stay data, requests for opioid refill and overall costs. METHODS AIS patients undergoing PSF from 2013 – 2019 were retrospectively reviewed. RRP patients received ITM as part of their multimodal analgesia. Fusion level-matched control patients received hydromorphone PCA for postoperative pain management. At discharge, PCA patients received 14-day prescriptions for oxycodone compared to 7-day prescriptions in the ITM group. Perioperative data, requests for opioid refill, and overall costs were analyzed. RESULTS A total of 363 patients were included (PCA: 255, RRP/ITM: 108). BMI (p=0.786) and preoperative Cobb (p=0.343) were similar. RRP patients had a significantly shorter length of stay (3 vs 5 days, p CONCLUSIONS With increasing concerns about opioid dependence and hospital costs, our RRP pathway, which incorporates microdose ITM injections, allows for optimum perioperative management, improved costs, with overall better outcomes than the traditional PCA. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.
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