Relationship of Hospital Bed Size and Healthcare Resource Utilization Following Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

Introduction: The aim of this study was to determine the impact of hospital bed size on post-operative complications, length of hospital stay (LOS), and hospital costs following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS).

Methods: A retrospective cohort study was performed using the 2016-2019 National Inpatient Sample database. Patients 10-17 years old with a primary diagnosis of AIS undergoing elective thoracic PSF were identified using ICD-10-CM codes. Patients were categorized by their treating hospital’s bed size (Small, Medium, and Large). Patient demographics, hospital characteristics, comorbidities, procedures, and outcomes were assessed. Multivariate logistic regression analyses were used to identify the impact of hospital bed size on extended LOS and increased cost.

Results: Of the 17,740 patients identified, 5,165 (29.1%) were in the Small cohort, 3,995 (22.5%) were in the Medium cohort, and 8,580 (48.4%) were in the Large cohort. Patients at Large hospitals generally had more comorbidities than patients at Small and Medium hospitals (p=0.006). Number of thoracic fusion levels were similar (p=0.648). Patients at Large hospitals experienced a greater proportion of adverse events (p=0.009). LOS (p=0.956) and discharge disposition (p=0.380) were similar across hospitals. Hospital costs were significantly lower at Large hospitals, and highest in Medium hospitals (p < 0.001). On multivariate analysis, Large (OR: 0.68, p< 0.001) and Medium (OR: 0.68, p< 0.001) hospital bed size were found to be independently associated with shorter LOS compared to Small hospital bed size. Additionally, Medium hospital bed size (OR: 1.92, p=0.012) was independently associated with increased hospital costs, while Large hospital bed size was associated with decreased costs (OR: 0.37, p< 0.001) compared to Small hospital bed size.

Conclusion : Our study suggests that hospital size may impact healthcare resource utilization after PSF for AIS. Identifying reasons for variability in healthcare resource utilization across hospitals may improve patient outcomes and reduce healthcare spending.