Abstract
Purpose
Enhanced 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.Methods
Retrospective 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.).Results
The 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 Conclusion
Protocol-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.