Trends and Outcomes in Adolescent Idiopathic Scoliosis Surgery: A Nationwide Analysis of Improvements From 2010 to 2022.

Study DesignRetrospective cohort study.ObjectivesTo evaluate national trends in management and outcomes of posterior spinal fusion for adolescent idiopathic scoliosis (AIS) over a 12-year period and characterize postoperative opioid utilization.MethodsWe used the PearlDiver Mariner database to identify patients aged 10-18 years with AIS undergoing posterior spinal fusion of >7 levels from 2010-2022. Patients were stratified into 2 epochs (2010-2015 and 2016-2022) to compare demographics, Elixhauser Comorbidity Index (ECI), surgical techniques, length of stay, complications, readmissions, revisions, and postoperative opioid prescriptions using chi-squared and t-tests. We also summarized characteristics across 3 eras (2010-2013, 2014-2017, 2018-2022) and fit year-by-year logistic regression models with 2010 as reference.ResultsAmong 17,541 AIS patients, prevalence increased while the surgery-to-prevalence ratio declined. The later cohort had higher comorbidity burden (ECI 0.99 vs 1.25, P < 0.001), greater use of Ponte osteotomies, navigation, and robotics, and less pelvic fixation. Length of stay decreased (5.04 vs 4.12 days, P < 0.001), along with 30-, 90-day, and 1-year readmissions; 30-day complications; 90-day infections; and 2-year revision and hardware removal rates. Opioid exposure declined across all intervals, with reduced prescription rates, cumulative MME, MME/day, and duration.ConclusionFrom 2010-2022, posterior spinal fusion for AIS shifted toward greater technological adoption and increased Ponte osteotomy utilization in patients with higher comorbidity burden, while also being associated with shorter hospitalization, fewer complications, lower revision and readmission rates, and reduced opioid exposure, supporting an overall improved safety profile of AIS surgery.