P88. Extended length of stay after complex adult spinal deformity surgery: predictors and impact on clinical and patient-reported outcomes

Abstract

BACKGROUND CONTEXT The prevalence and demand for adult spinal deformity surgery continues to increase. In an era with greater scrutiny over surgical outcomes, there has been increasing emphasis on understanding the risk factors and predictors for extended LOS. Outside of its obvious effect on cost, few studies have looked into the impact that LOS has on clinical outcomes and PROs. Few studies have looked into the impact that length of stay has on clinical outcomes and patient reported outcomes. We hypothesized that patients with extended LOS experience worse clinical and PROs. We aimed to study the effect that extended LOS has on complex ASD patients with regards to clinical outcomes and PROs. PURPOSE We hypothesize that patients with patients with extended length of stay (LOS) experience worse clinical and patient reported outcomes (PROs) on followup. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE Adult (≥18years old) patients with complex ASD surgery (defined as minimum 6 fusion levels, range 6-23) at a single institution from 2015 to 2018 with up to 2-year follow-up. OUTCOME MEASURES Patient reported outcome measures including SRS and ODI scores. METHODS This was a retrospective review of consecutively collected adult (≥18years old) patients with complex ASD surgery (defined as minimum 6 fusion levels, range 6-23) at a single institution from 2015 to 2018 with up to 2-year follow-up. Bivariate analysis was performed on perioperative factors. Independent risk factors for extended LOS were identified using multivariate logistic regression. RESULTS A total of 191 patients were included after exclusion criteria. Fifty-nine (30.9%) patients had extended LOS (>=8 days; defined as the 75th percentile LOS). The average LOS was eight days (Range LOS was 3-52). Preoperative ODI was associated with extended LOS in the bivariate but not predictive of extended LOS in the multivariate logistic regression. Extended LOS was not associated with readmission or reoperation rates. No significant differences were noted in HRQOL scores between those patients with normal and extended LOS. Multivariate logistic regression analysis an ASA >=3, a higher number of instrumented levels, and operative time >7 hours were independently associated with an extended LOS. CONCLUSIONS Extended LOS was found in patients ASA≥3, increased number of instrumented levels and operative times >7 hours. However, an extended LOS is not associated with worse PROs and clinical outcomes at 1 and 2 years postsurgery, nor was an extended LOS associated with higher readmission or reoperation rates. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.