Factors Affecting Length of Stay Following Elective Anterior and Posterior Cervical Spine Surgery

Abstract

BackgroundDisease of the cervical spine is widely prevalent, most commonly secondary to degenerative disc changes and spondylosis.ObjectiveThe goal of the paper was to identify a possible discrepancy regarding the length of stay (LOS) between the anterior and posterior approaches to elective cervical spine surgery and identify contributing factors.MethodsA retrospective study was performed on 587 patients (341 anterior, 246 posterior) that underwent elective cervical spinal surgery between October 2001 and March 2014. Pre- and intraoperative data were analyzed. Statistical analysis was performed using GraphPad Prism 5 (GraphPad Software, Inc., La Jolla, CA) and the Statistical Package for Social Sciences (SPSS) (IBM SPSS Statistics, Armonk, NY).ResultsAverage LOS was 3.21 ± 0.32 days for patients that benefited from the anterior approach cervical spinal surgery and 5.28 ± 0.37 days for patients that benefited from the posterior approach surgery, P-value < 0.0001. Anterior patients had lower American Society of Anesthesiologists scores (2.43 ± 0.036 vs. 2.70 ± 0.044). Anterior patients also had fewer intervertebral levels operated upon (2.18 ± 0.056 vs. 4.11 ± 0.13), shorter incisions (5.49 ± 0.093 cm vs. 9.25 ± 0.16 cm), lower estimated blood loss (EBL) (183.8 ± 9.0 cc vs. 340.0 ± 8.7 cc), and shorter procedure times (4.12 ± 0.09 hours vs. 4.47 ± 0.10 hours). Chi-squared tests for hypertension, coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease, and asthma showed no significant difference between groups.Conclusions:Patients with anterior surgery performed experienced a length of stay that was 2.07 days shorter on average. Higher EBL, longer incisions, more intervertebral levels, and longer operating time were significantly associated with the posterior approach. Future studies should include multiple surgeons. The goal would be to create a model that could accurately predict the postoperative length of stay based on patient and operative factors.

Length of stay associated with posterior cervical fusion with intervertebral cages: experience from a device registry

“…Estimated blood loss during an open, posterior cervical fusion range from 225 to 480 mL (4,(17)(18)(19)22,27), which is substantially greater than our highest average blood loss of 75 mL among stand-alone patients. For procedural time, our highest [11] average estimate in patients having a circumferential fusion, 88 min, was also lower than the range of 110-270 min for posterior cervical fusion (4,17,22,27,28). Adopting tissue-sparing procedures for treating common degenerative disorders of the lumbar spine has resulted in substantial reductions in length of stay and, correspondingly, in lower costs (29,30).…”

“…Our average length of stay compares favorably with studies employing open posterior lateral mass fixation and instrumented fusion. Numerous singlecenter studies have reported average lengths of stay following posterior cervical fusion ranging from 4.0 to 7.3 days (3,4,(17)(18)(19)(20)(21)(22). Several other studies reporting length of stay following posterior cervical fusion are of note due to their large sample sizes.…”

“…When conservative medical management fails to ameliorate chronic symptoms of cervical myeloradiculopathy, operative decompression and fusion is indicated. Although it provides satisfactory clinical results, posterior cervical laminectomy and lateral mass fixation with instrumentation requires wide operative dissection with disruption of musculo-ligamentous and neural structures, resulting in higher blood loss, longer operating time and lengthier hospital stays than anterior fusion approaches (4,5).…”

Tissue-Sparing Posterior Cervical Fusion With Interfacet Cages: A Systematic Review of the Literature

“…13 The mean LOS across our entire systematic review ranged from 26 to 33.6 hours 13 -15,17 and suggests a significant improvement on traditional posterior cervical fusion, which ranges from 4.0 to 7.3 days. 21 -28 Additionally, the mean EBL in this review ranged from 32.83 to 87.8 cm 3 for the tissue-sparing, posterior interfacet fusion, 13 -15,17 which compares favorably to open posterior cervical fusions (range, 225-480 cm 3 ). 21 -28…”

Health Care Resource Utilization in Commercially Insured Patients Undergoing Anterior Cervical Discectomy and Fusion for Degenerative Cervical Pathology

“…In ACDF surgeries that warrant inpatient admission, minimizing hospital length of stay may serve as an important potential cost reduction measure, as length of stay is known to be a large driver of hospitalization costs. 17 , 18 There are many known risk factors that may predispose patients to prolonged length of stay following spine surgery, 19 and there is evidence that implementation of accelerated discharge pathways may reduce length of stay. 20 Actively mitigating these risk factors and implementing interventions aimed at reducing length of stay may be potential targets for surgery-related cost reduction.…”