Predictors of extended length of stay related to craniotomy for tumor resection

Abstract

BackgroundHospital length of stay (LOS) related to craniotomy for tumor resection (CTR) is a marker of neurosurgical quality of care. Limiting LOS benefits both patients and hospitals. This study examined which factors contribute to extended LOS (eLOS) at our academic center. MethodsRetrospective medical record review of 139 consecutive CTRs performed between July 2020 and July 2021. Univariate and multivariable analyses determined which factors were associated with an eLOS (≥8 days). ResultsMedian LOS was 6 days (IQR 3–9 days). Fifty-one subjects (36.7%) experienced an eLOS. Upon univariate analysis, potentially modifiable factors associated with eLOS included days to occupational therapy (OT), physical therapy (PT), and case management clearance (p < .001); and discharge disposition (p < .001). Multivariable analysis revealed that pre-operative anti-coagulant use (OR 10.74, 95% CI 2.64–43.63, p = .001), Medicare (OR 4.80, 95% CI 1.07–21.52, p = .04), ED admission (OR 26.21, 95% CI 5.17–132.99, p < .001), transfer to another service post-surgery (OR 30.00, 95% CI 1.56–577.35, p = .02), and time to post-operative imaging (OR 2.91, 95% CI 1.27–6.65, p = .01) were associated with eLOS. Extended LOS was not significantly associated with ED visits (p = .45) or unplanned readmissions within 30 days of surgery (p = .35), and both (p = .04; p = .04) were less likely following a short LOS (<5 days). ConclusionWhile some factors driving LOS related to CTR are uncontrollable, expedient pre- and post-operative management may reduce LOS without compromising care.