Abstract
BackgroundAtlantoaxial fusion is an effective procedure for treating degenerative, traumatic, and congenital abnormalities that result in upper cervical instability; however, data on which factors affect the length of stay and hospitalization-related charges are limited. The purpose of this study was to evaluate the pre-, intra-, and postoperative variables that affect these healthcare cost factors for patients undergoing posterior atlantoaxial fusion.MethodsWe retrospectively identified from a clinical database 59 patients who underwent isolated posterior atlantoaxial fusion at a single institution from 2010 to 2015. Demographic, clinical, and surgical variables from a clinical database were analyzed with respect to the length of hospital stay and hospital charges. T-test and Chi-square testing, as well as univariate and multivariable analysis, were performed with p<0.05 considered significant.ResultsOn multivariable analysis, a variety of preoperative, intraoperative, and postoperative variables were associated with prolonged hospitalization and higher hospital charges, including tobacco use, preoperative diagnosis, operating room time, and the need for intraoperative blood transfusion.ConclusionsVaried preoperative, intraoperative, and postoperative factors are associated with increased length of hospitalization and higher hospital charges after atlantoaxial fusion. Familiarity with these factors may allow for improved surgical planning and patient counseling.
Highlights
Because of its complex anatomy, the atlantoaxial region is uniquely vulnerable to certain degenerative, traumatic, and neoplastic pathological conditions [1]
We retrospectively identified from a clinical database 59 patients who underwent isolated posterior atlantoaxial fusion at a single institution from 2010 to 2015
A variety of preoperative, intraoperative, and postoperative variables were associated with prolonged hospitalization and higher hospital charges, including tobacco use, preoperative diagnosis, operating room time, and the need for intraoperative blood transfusion
Summary
Because of its complex anatomy, the atlantoaxial region is uniquely vulnerable to certain degenerative, traumatic, and neoplastic pathological conditions [1]. Fusion rates after posterior cervical fusion range from 93% to 99% [3] and rates of complications are low (2%–4%) [4], there is a lack of information regarding what factors influence the length of hospitalization itself [5] An understanding of such influences is becoming increasingly important as surgical care becomes more outcomes focused [6], and measures, such as length of stay (LoS), are associated with the incidence of more serious complications, such as postoperative infection [7] and thrombotic events [8]. Atlantoaxial fusion is an effective procedure for treating degenerative, traumatic, and congenital abnormalities that result in upper cervical instability; data on which factors affect the length of stay and hospitalization-related charges are limited. The purpose of this study was to evaluate the pre-, intra-, and postoperative variables that affect these healthcare cost factors for patients undergoing posterior atlantoaxial fusion
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