P70. Predictors of extended length of stay and discharge disposition following elective lumbar spine surgery

Abstract

<h3>BACKGROUND CONTEXT</h3> In the context of increased attention afforded to hospital efficiency and safe patient throughput, safely decreasing hospital length of stay (LOS) is imperative. About 10% of patients contribute to 63% of all US health care expenditures. Given that lumbar spine procedures can be among a hospital's most profitable services, identifying patients at risk of extended LOS (eLOS) prior to surgery is a valuable opportunity to develop targeted pre- and perioperative intervention and quality improvement initiatives. We sought to elucidate patient factors that predict prolonged LOS as well as discharge disposition following elective lumbar spine surgery. <h3>METHODS</h3> We performed a retrospective cohort analysis on data collected between 2015 and 2021 from a single, large academic center following elective posterior, nonendoscopic, lumbar laminectomy, discectomy, microdiscectomy, foraminotomy and/or facetectomy without fusion. The primary outcome measure was eLOS following surgery, defined as the 90^th percentile or greater in the number of midnights admitted postprocedurally (three or more). Patient sociodemographic, procedural and discharge characteristics were collected. Sociodemographic variables included Area of Deprivation Index (ADI), a comprehensive metric of socioeconomic status, utilizing income, education, employment and housing quality based on patient zip code. Multivariable logistic and ordinal logistic regression analyses were performed to assess whether covariates were independently predictive of eLOS and discharge disposition, respectively. Discharge to home served as a reference category with the other two dispositions being to home with services and to a SNF or acute rehab. <h3>RESULTS</h3> There were 779 patients in the study, with a median age of 66 years (±15) and a median LOS of 1 midnight (range, 1-10 midnights). Results demonstrated that patients in the most disadvantaged ADI quintile (OR 2.48 95% CI 1.14-5.40), who underwent minimally invasive surgery (OR 3.03 95% CI 1.06-8.74), who had an intraoperative drain placed (OR 4.46 95% CI 2.50-7.17), who had a CSF leak (OR 3.46 95% CI 1.57-7.62), who were discharged anywhere but home (OR 17.11 95% CI 9.07-32.26), and who were evaluated by PT (OR7.2395% CI 1.69-30.87) or OT (OR 2.20 95% CI 1.14-4.23) had a significantly increased chance of an eLOS. Preoperative opioid use was not associated with an increased LOS following surgery (OR 1.12 95% CI 0.69-1.80). Extended LOS was not associated with ED representation and readmission risk within 90 days following discharge (p=0.148). Patients who were older (OR 1.99 95% CI 1.62-2.48), in higher quintiles on ADI (3rdquintile; OR 1.90 95% CI 1.12-3.23, 4^thquintile; OR 1.79, 95% CI 1.05-3.05, 5thquintile; OR 2.16 95% CI 1.26-3.75), who had a CSF leak (OR 2.18 95% CI 1.22-3.86), or who had a longer procedure duration (OR 1.38 95% CI 1.17-1.62) were more likely to be discharged with some kind of support service. <h3>CONCLUSIONS</h3> Patient sociodemographics, along with procedural factors, and discharge characteristics were all associated with an increased chance of eLOS and disproportionate health care utilization with elective lumbar spine surgery. Notably, some of these identified factors could be reliably identified in a preoperative visit and therefore may be amenable to targeted preoperative intervention. Improving discharge disposition planning in the perioperative period may allow for reduced inpatient length of stays. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.