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.