A retrospective analysis of surgical, patient, and clinical characteristics associated with length of stay following elective lumbar spine surgery

Abstract

BackgroundElective spine surgeries consume significant hospital resources, contributing greatly to the costs of care. Length of stay (LOS) is the major cost driver for most hospitals. This study aimed to describe the demographic, clinical, operative, and postoperative characteristics of patients undergoing elective lumbar spine with wide-ranging rural discharge destinations, and how these characteristics are independently associated with LOS. MethodsThis was a retrospective cohort study of patients at a quaternary institution undergoing surgery for single or two level lumbar degenerative conditions over a two year period. LOS was calculated as the number of days from the date of surgery to the date of discharge. A multiple quasi-Poisson regression was used to describe the characteristics independently associated with LOS. Surgery group was stratified when feasible to explore heterogeneity within the study population. ResultsA total of 473 patients met inclusion criteria. The median LOS was 3.0 days (Interquartile range (IQR) = 1–4) for the entire population, 4.0 days (IQR = 3–6) for 1-level transforaminal lumbar interbody fusion (TLIF) patients, 0 days (IQR = 0–1) for discectomy patients, and 2.0 days (IQR = 1–4) for laminectomy patients. Factors that were statistically significantly associated with LOS in adjusted analyses were age, BMI, preoperative antidepressant use, surgery group, long-acting intraoperative analgesics, operating surgeon, and postoperative blood transfusion. Stratified multivariable analysis showed effect modification by surgery group. ConclusionLOS following elective lumbar spine surgery for degenerative conditions is associated with several patient, clinical, and surgical factors and is highly dependent on the type of surgical procedure performed. Building predictive models for anticipated LOS can help hospitals plan for ideal resource use and scheduling.