青少年特发性脊柱侧弯后路脊柱融合术后静脉注射至口服阿片类药物转换时间与住院时间的关联
Association Between Intravenous to Oral Opioid Transition Time and Length of Hospital Stay After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis.
作者信息
Hengartner Astrid C, Havlik John, David Wyatt B, Reeves Benjamin C, Freedman Isaac G, Sarkozy Margot, Maloy Gwyneth, Fernandez Tiana, Craft Samuel, Koo Andrew B, Tuason Dominick A, DiLuna Michael, Elsamadicy Aladine A
机构信息
Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA.
Department of Orthopedics, Yale University School of Medicine, New Haven, CT, USA.
出版信息
Int J Spine Surg. 2023 Jun;17(3):468-476. doi: 10.14444/8448. Epub 2023 Apr 19.
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% ( = 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).
CONCLUSIONS
Longer postoperative IV to oral opioid transitions after PSF for AIS may have implications for hospital LOS.
背景
青少年特发性脊柱侧凸（AIS）后路脊柱融合术（PSF）术后，从静脉注射（IV）阿片类药物过渡到口服阿片类药物是必要的。然而，很少有研究评估较长的过渡时间对住院时间（LOS）的影响。本研究调查了AIS患者PSF术后较长的IV到口服阿片类药物过渡时间对LOS的影响。
方法
回顾了2013年至2020年在一所主要学术机构接受多级PSF的129名青少年（10 - 18岁）AIS患者的病历。患者按IV到口服阿片类药物的过渡时间分类：正常（≤2天）与延长（≥3天）。评估患者的人口统计学、合并症、畸形特征、术中变量、术后并发症和LOS。采用多变量分析确定风险调整后延长LOS的比值比。
结果
在129名研究患者中，29.5%（n = 38）的患者IV到口服的过渡时间延长。两组患者的人口统计学和合并症相似。两组患者的主弯度数（P = 0.762）和融合节段的中位数（四分位间距）（P = 0.447）相似，但延长组的手术时间明显更长（正常组：6.6 ± 1.2小时 vs 延长组：7.2 ± 1.3小时，P = 0.009）。两组患者的术后并发症发生率相似。过渡时间延长的患者LOS明显更长（正常组：4.6 ± 1.3天 vs 延长组：5.1 ± 0.8天，P < 0.001），但出院处置情况相似（P = 0.722），30天再入院率相似（P = 0.99）。单变量分析显示，过渡时间与延长的LOS显著相关（OR：2.0，95% CI [0.9, 4.6]，P = 0.014），但多变量分析时这种相关性不显著（调整后OR：2.1，95% CI [1.3, 4.8]，P = 0.062）。
结论
AIS患者PSF术后较长的术后IV到口服阿片类药物过渡时间可能对住院LOS有影响。
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