Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters

Abstract

BACKGROUND CONTEXT Minimally invasive lumbar discectomy (MIS LD) has proven to be an effective treatment modality for low back pain and radiculopathy associated with intervertebral disc herniations. With the increasing focus on cost reduction and value-based care, minimization of postoperative length of stay has become an important topic for physicians and hospital administrators. Despite this, risk factors for prolonged length of stay after MIS LD have not been previously described. PURPOSE To determine risk factors for discharge after postoperative (POD) 0 in patients undergoing one-level MIS LD. STUDY DESIGN/SETTING Retrospective cohort. PATIENT SAMPLE A total of 176 patients who underwent one-level MIS LD from 2011 to 2016. OUTCOME MEASURES Relative Risk (RR) of preoperative and operative characteristics for discharge after POD 0. METHODS A prospectively maintained surgical database of patients who underwent one-level MIS LD by a single surgeon from 2011 to 2016 was reviewed. Long length of stay was defined as discharge after POD 0. Bivariate and stepwise multivariate Poisson regression with robust error variance was used to determine risk factors for discharge after POD 0. Variables analyzed included patient demographics, comorbidities, operative characteristics, preoperative pain scores, postoperative inpatient pain scores and postoperative narcotics consumption as measured by oral morphine equivalents (OMEs). A p-value RESULTS A total of 176 patients were included in this analysis. 9.7% of included patients were discharged on POD 1 or later, qualifying as having a long length of stay. On bivariate analysis, diabetic status (57.1% vs. 7.7%, Relative Risk [RR]=7.43, p CONCLUSIONS The results of this study suggest that patients with diabetes mellitus and those with low postoperative narcotic consumption have longer lengths of inpatient stay upon undergoing a one-level MIS LD. Diabetic patients may experience longer length of stay due to requiring extensive postoperative blood glucose management or as a result of increased susceptibility to postoperative infection. Surgeons can use this information to better counsel patients on expected length of stay and optimal narcotics utilization postoperatively.