P80. Effect of preoperative education on length of stay after elective spinal fusion: a prospective comparative cohort study

Abstract

<h3>BACKGROUND CONTEXT</h3> Length of stay (LOS) is a major component of hospital cost of inpatient care. Preoperative surgical education has shown to reduce length of stay and overall hospital cost in the orthopedic literature. This same benefit has not been widely studied in patients undergoing spine surgery. <h3>PURPOSE</h3> We sought to demonstrate that preoperative spine surgery education decreases LOS and time-to-first-ambulation after elective spinal fusion. <h3>STUDY DESIGN/SETTING</h3> This is a prospective observational cohort study. We prospectively followed consecutive patients who underwent elective minimally invasive spinal fusion in two hospitals under multiple surgeons from May 2021 through September 2021. The patient population we pulled from was all patients who underwent elective lumbar and cervical fusion including patients with auto or worker's compensation. Patients were excluded if they underwent kyphoplasty or had surgery in the thoracic, C1, pelvis or sacroilliac joint regions. <h3>PATIENT SAMPLE</h3> Four hundred and twelve patients were included. <h3>OUTCOME MEASURES</h3> Our primary outcome for this study was length of stay. Our secondary outcomes were postoperative-day-0 ambulation (POD#0) and first-ambulation distance. <h3>METHODS</h3> Multidisciplinary meetings were held to develop the preoperative spine surgery education material which included a hardcopy booklet, a video embedded in an online quiz and a designated webpage (spineclass.michiganspineandbrainsurgeons.com). This component was part of our institutional Enhanced Recovery After Surgery (ERAS) protocol. During surgical scheduling, patients viewed the video on a tablet. They were given the booklet followed by an email with links to the webpage and pdf booklet. The process measures were compliance with completing the video/quiz and a quiz score with >50% as the passing score. Patient demographics, particularly types of insurance were collected. Univariate analyses were used to compare the compliance groups and multivariable analysis was done to identify factors independently associated with length of stay; p<0.05 was considered significant. <h3>RESULTS</h3> Four hundred and twelve patients were included. Sixty-eight (16.5%) patients viewed the video and completed the online quiz. Average quiz score 79.7 ± 10.8 with a 100% passing rate. There was no significant difference in patient and operative characteristics between the two groups. Compliant patients had a significantly shorter LOS (1.4 ± 1.3, 2.1 ± 2.7, p = 0.45). Preop spine video (B: -0.64, 95% CI: -1.29 - 0, p = 0.050) education was independently associated with a significant decrease in LOS; the converse was true for age (B: 0.05, 95% CI: 0.03 - 0.07, p = <.001). <h3>CONCLUSIONS</h3> We demonstrated that preoperative spine education significantly decreased LOS. Further study to improve compliance is necessary. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.