Impact of Longer Surgical Wait-List Times on Length of Hospitalisation, Return to Function and Cost of Surgical Treatment in Patients with Adolescent Idiopathic Scoliosis undergoing Posterior Spinal Fusion

Abstract

IntroductionDespite the known clinical and functional benefits of timely surgery in adolescents with idiopathic scoliosis (AIS), several patients still undergo surgery for scoliotic deformity correction when curves have progressed beyond 70°. More evidence is needed assessing the effect of long surgical wait-list times on patient outcomes including return to function, intrasurgical factors and cost of surgical treatment. This study aimed to report on surgical wait-list times in a cohort of patients with AIS undergoing posterior spinal fusion (PSF), and examine potential correlations with selected patient outcomes including: intrasurgical factors, length of hospitalisation, return to function and cost of surgical treatment. Material and MethodsA prospective longitudinal cohort study involving the recruitment and follow up of 77 consecutive and eligible patients with a diagnosis of AIS, from two tertiary centres, over a two year period, until return to function (e.g., school/college, physical activity) was reported. Surgical wait-list times were analyzed in relation to timing of return to function, cost of surgical treatment (€), intrasurgical factors (surgical duration, estimated blood loss) and length of hospitalisation. In accordance with local criteria, a long surgical wait list time was defined as ‘greater than 6 months’. SPSS® was used to analyze the data; non-parametric Spearman correlation coefficient was used in all correlation analyses (rs). ResultsThe median surgical wait-list time in the cohort was 33 weeks (interquartile range 19–56 weeks). Almost two thirds of patients waited beyond 6 months for surgery (62.3%; n = 48); twelve patients (15.5%) waited beyond 18 months. Patients who waited beyond 6 months had a significantly larger preoperative curve (65° ± SD 14 versus 58° ± SD 10) and the cost of surgical treatment per patient was significantly greater (mean €32,652 versus €27,629, P < 0.0001). In addition, longer surgical wait list times strongly correlated with a significantly longer surgical duration (rs = 0.565, P < 0.0001) and higher blood loss (rs = 0.27, p = 0.044). No significant correlations were found between surgical wait-list times and length of hospitalisation, timing of return to school/college or physical activity. ConclusionEfforts to support waiting list initiatives in the AIS population are likely to give rise to significantly reduced surgical cost, less complex surgeries and more manageable curvatures being dealt with in a timely fashion.