ArticleSpine deformity2026
Less opioid at no extra cost: charge-code decomposition of an ERAS pathway for adolescent scoliosis surgery.
Article in Spine deformity, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeEnhanced recovery after surgery (ERAS) pathways using dexamethasone and liposomal bupivacaine (Dex/LB) have been shown to reduce opioid use after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS), but their economic impact is unknown. This study examined whether the Dex/LB pathway increases hospital cost, analyzing charge lines rather than encounter-level totals.
methodsRetrospective sequential implementation study at a single pediatric center. Of 140 consecutive AIS patients undergoing PSF (2019-2025), a transitional cohort (n = 20) was excluded, leaving 120 for primary analysis: traditional (n = 87) versus Dex/LB (n = 33). Charge lines were classified a priori as protocol-sensitive (medication, hospital stay, anesthesia/recovery) or protocol-independent (implant cost, imaging, laboratory studies, etc.).
resultsThe Dex/LB group had lower inpatient opioid use (median 30.0 vs. 150.0 MME; adjusted - 133.7, 95% CI - 177.1 to - 90.3, P < 0.001) and shorter length of hospital stay (LOS) (2.1 vs. 2.8 days, P < 0.001; adjusted P = 0.46). Total Direct Cost was higher in the DEX/LB cohort ($57,288 vs. $50,780, P = 0.006), but protocol-sensitive Direct Cost did not differ ($5873 vs. $6324; adjusted +$326, 95% CI - $679 to $1330, P = 0.52), with decrease LOS offsetting increased LB cost. The total cost increase traced to implant charges (+ $7034, P < 0.001) from concurrent billing changes. When implants were excluded, total Direct Cost did not differ (- $880, P = 0.58). Cost equivalence was sensitive to payer composition (Medicaid exclusion: +$596, P = 0.035).
conclusionProtocol-sensitive Direct Cost did not differ significantly between the Dex/LB and traditional pathways. The apparent total cost increase was attributable to concurrent changes in implant charge capture unrelated to the analgesic protocol.
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