Safe, Satisfied, and Home Early: Patient-Reported Outcomes of Next-Day Discharge Following Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis.

BACKGROUND

Enhanced recovery pathways have enabled shorter hospitalizations following posterior spinal instrumented fusion (PSIF) for adolescent idiopathic scoliosis (AIS), including next-day discharge (NDD). Although NDD has demonstrated favorable safety outcomes, its impact on patient-reported outcomes (PROs) remains unknown. This study compared postoperative PROs between patients discharged on postoperative day 1 and those with longer hospitalizations and secondarily evaluated whether preoperative PRO measures were associated with successful NDD.

METHODS

A retrospective secondary analysis was performed of a previously published cohort of AIS patients aged 10 to 18 years who underwent primary posterior-only PSIF between 2017 and 2022 with a standard intra- and postoperative care pathway. Prospectively collected preoperative and 6-month postoperative PROs included Scoliosis Research Society (SRS)-22r, Spinal Appearance Questionnaire (SAQ), and PRO Measurement Information System (PROMIS) domains. Patients were grouped by discharge status: NDD (postoperative day 1) and postoperative day >2 (POD>2). Group comparisons and Spearman correlation analyses were performed.

RESULTS

Of 111 eligible surgical patients, 91 had analyzable PRO data (32 NDD, 59 POD>2). Mean age was 14.3 years (range: 11 to 18), 77% (n=85) were female, and 35% (n=39) were discharged on POD1. No significant differences existed between groups in demographic, radiographic, or perioperative characteristics. Preoperative SRS-22r, SAQ, and PROMIS scores did not differ between groups, and no significant associations were identified between baseline PROs and length of stay. Postoperatively, there were no significant between-group differences in SAQ, SRS-22r function, pain, self-image, mental health, or PROMIS domains. Satisfaction scores were slightly higher in POD>2 patients (4.7 vs. 4.4, P=0.04); however, the magnitude of difference (0.3) was below established minimally clinically important difference thresholds. Both groups demonstrated significant postoperative improvement across PRO measures. Length of stay demonstrated a modest positive correlation with postoperative SRS-22r Function (rs=0.34, adjusted P=0.042).

CONCLUSIONS

Patients discharged on POD1 following PSIF for AIS demonstrated short-term postoperative PROs comparable to patients with longer hospitalizations. Baseline SRS-22r, SAQ, and PROMIS measures were not associated with successful NDD. Accelerated discharge pathways may preserve patient-perceived recovery while maintaining previously demonstrated safety benefits.

LEVEL OF EVIDENCE: Level III.