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. 2025 Jul 1.
doi: 10.1007/s43390-025-01112-0. Online ahead of print.

The impact of a multi-disciplinary care pathway on intensive care unit and total hospital length of stay in high-risk neuromuscular scoliosis patients who require posterior spinal fusion: a quality improvement study

Lorena V Floccari  1 , Bryce Pember  2 , Kenzie D Lundqvist  3 , Matthew B Holloway  3   4 , Richard P Steiner  3 , Michael T Bigham  5 , Kenneth T Bono  3 , Todd F Ritzman  3
Affiliations

The impact of a multi-disciplinary care pathway on intensive care unit and total hospital length of stay in high-risk neuromuscular scoliosis patients who require posterior spinal fusion: a quality improvement study

Lorena V Floccari et al. Spine Deform. .

Abstract

Purpose: The purpose of this study was to establish a multi-disciplinary consensus-based standardized perioperative care pathway for high-risk neuromuscular scoliosis (NMS) patients requiring posterior spinal fusion (PSF) and to compare patient outcomes before and after its implementation.

Methods: A retrospective comparative cohort study was performed at a freestanding children's hospital in the United States. A multi-disciplinary team reviewed published evidence and developed a consensus-based standardized perioperative pathway that was implemented in May 2018. Pre-pathway (1/2014-4/2018) NMS patients with complex multi-system involvement who underwent PSF were compared to post-pathway (5/2018-12/2023) patients in demographics, radiographic characteristics, surgical variables, disposition, length of stay (LOS), and complications.

Results: Ninety-one patients were included (30 pre-pathway, 61 post-pathway). There were no significant differences in patient demographics or curve characteristics. Central venous catheters were used more often in the pre-pathway group (50.0% vs 27.9%, p = 0.039). The post-pathway group had longer mean fusion length (14.4 vs 15.3 levels, p = 0.015), greater frequency of pelvic instrumentation (43.3% vs 73.8%, p = 0.005), and a longer mean operative time (316 vs 357 min, p = 0.032). The post-pathway group had a significantly shorter median intensive care unit (ICU) LOS (2.5 vs 2.0 nights, p = 0.017) and a significantly shorter median hospital LOS (7.5 vs 5.0 days, p < 0.001). There were no statistically significant differences in early complications.

Conclusion: After implementation of a comprehensive multi-disciplinary pathway for high-risk scoliosis patients, patients had a 20% shorter median ICU LOS and a 33% shorter median hospital LOS despite more complex surgeries. Both groups had a similar incidence of early postoperative complications.

Level of evidence: Level III.

Keywords: Neuromuscular scoliosis; Perioperative pathway; Posterior spinal fusion; Quality improvement.

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Conflict of interest statement

Declarations. Competing interests: The authors have no competing interests to declare that are relevant to the content of this article. JMP statistical software, v. 17, was used for statistical analyses. Ethics approval: Institutional review board (IRB) approval was obtained to perform retrospective analyses of our patient population for comparison of specific patient and surgical variables prior to and after pathway implementation.

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