Neighborhood-Level Socioeconomic Status Predicts Extended Length of Stay After Elective Anterior Cervical Spine Surgery

Abstract

A significant portion of health care spending is driven by a small percentage of the overall population. Understanding risk factors predisposing patients to disproportionate use of health care resources is critical. Our objective was to identify risk factors leading to a prolonged length of stay (LOS) after cervical spine surgery. A single-center cohort analysis was performed on patients who underwent elective anterior spine surgery from 2015 to 2021. Multivariate logistic regression evaluated the effects of sociodemographic factors including Area of Deprivation Index (quantifies income, education, employment, and housing quality), procedural, and discharge characteristics on postoperative LOS. Extended LOS was defined as greater than the 90th percentile in midnights for the study population (≥3 midnights). A total of 686 patients were included in the study, with a mean age of 57 years (range, 26-92 years), median of 1 level (1-4) fused, and median LOS of 1 midnight (interquartile range, 1-2). After adjusting for confounders, patients had increased odds of extended LOS if they were highly disadvantaged on the Area of Deprivation Index (odds ratio [OR], 2.24; 95% confidence interval [CI], 1.04-4.82; P= 0.039); had surgery on Thursday or Friday (OR, 1.94; 95% CI, 1.01-3.72; P= 0.046); had a corpectomy performed (OR, 2.81; 95% CI, 1.26-6.28; P= 0.012); or discharged not to home (OR, 8.24; 95% CI, 2.88-23.56; P<0.001). Patients with extended LOS were more likely to present to the emergency department or be readmitted within 30 days after discharge (P= 0.024). After adjusting for potential cofounders, patients most disadvantaged on Area of Deprivation Index were more likely to have an extended LOS.