Inpatient Opioid Use After Rapid Recovery Protocol for Posterior Spinal Fusion in Adolescent Idiopathic Scoliosis

Background Rapid recovery pathways reduce opioid use after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS), but inpatient opioid consumption patterns and associated factors within these pathways remain incompletely defined. Methods We retrospectively reviewed 160 patients with AIS who underwent PSF at a single tertiary children’s hospital managed with a rapid recovery protocol. Outcomes included total inpatient opioid use (oral morphine equivalents [OME]/kg), PCA pushes/hour, and PRN opioid requests per postoperative day (POD). We evaluated associations between patient/surgical factors and inpatient opioid metrics, and between inpatient opioid metrics and post-discharge outcomes (opioid refills and pain at follow-up) using univariate analyses and regression modeling. Results Mean inpatient opioid consumption was 2.8 OME/kg (2.1 OME/kg PCA; 0.8 OME/kg PRN). Patients averaged 0.9 PCA pushes/hour and 2.5 PRN requests/POD. Higher total OME/kg was associated with age ≥15 years ( P = .048), preoperative pain ( P = .49), and ≥12 levels fused ( P = .02). Higher PCA use was associated with preoperative pain ( P = .009) and ≥12 levels fused ( P = .008), while increased PRN requests were associated with age ≥15 years ( P = .03) and operative time ≥6 h ( P = .04). All three inpatient opioid use metrics were associated with post-discharge opioid refill; PRN requests/POD were associated with pain at 6 weeks, and total OME/kg and PCA pushes/hour were associated with pain at 6 months (all P < .05 for these associations). Conclusions In a rapid recovery pathway, older age, preoperative pain, greater number of levels fused, and longer operative time were associated with increased inpatient opioid use after PSF for AIS. These factors may help anticipate analgesic needs and guide perioperative counseling and pain management.