Influence of Time of Discharge and Length of Stay on 30-Day Outcomes After Elective Anterior Cervical Spine Surgery

Abstract

BACKGROUND:Encouraging early time of discharge (TOD) for medical inpatients is commonplace and may potentially improve patient throughput. It is unclear, however, whether early TOD after elective spine surgery achieves this goal without a consequent increase in re-presentations to the hospital.OBJECTIVE:To evaluate whether early TOD results in increased rates of hospital readmission or return to the emergency department after elective anterior cervical spine surgery.METHODS:We analyzed 686 patients who underwent elective uncomplicated anterior cervical spine surgery at a single institution. Logistic regression was used to evaluate the relationship between sociodemographic, procedural, and discharge characteristics, and the outcomes of readmission or return to the emergency department and TOD.RESULTS:In multiple logistic regression, TOD was not associated with increased risk of readmission or return to the emergency department within 30 days of surgery. Weekend discharge (odds ratio [OR] 0.33, 95% CI 0.21-0.53), physical therapy evaluation (OR 0.44, 95% CI 0.28-0.71), and occupational therapy evaluation (OR 0.32, 95% CI 0.17-0.63) were all significantly associated with decreased odds of discharge before noon. Disadvantaged status, as measured by area of deprivation index, was associated with increased odds of readmission or re-presentation (OR 1.86, 95% CI 0.95-3.66), although this result did not achieve statistical significance.CONCLUSION:There does not appear to be an association between readmission or return to the emergency department and early TOD after elective spine surgery. Overuse of inpatient physical and occupational therapy consultations may contribute to decreased patient throughput in surgical admissions.

Time of Discharge and 30-Day Re-Presentation to an Acute Care Setting After Elective Lumbar Decompression Surgery

“…The statistical analyses, including univariate and multiple logistic regression approaches, used in this study have been previously described in detail by the authors. 24 Generalized linear modeling was used as applicable. Continuous variables including age, procedure start time, procedure duration, and discharge time were normalized.…”

“…Variable selection decisions largely, but not completely, parallel our previously described work on this subject. 24 In this analysis, we similarly evaluated and adjusted for multiple categories of covariates in this study including sociodemographic, procedural, and discharge characteristics. Sociodemographic features included age, insurance status, primary language, and area of deprivation index (ADI), a commonly used metric of socioeconomic disadvantage as measured by zipcode.…”

“…Sociodemographic features included age, insurance status, primary language, and area of deprivation index (ADI), a commonly used metric of socioeconomic disadvantage as measured by zipcode. 24-27 In this study, ADIs were split into quintiles. 1-4…”

“…Sociodemographic features included age, insurance status, primary language, and area of deprivation index (ADI), a commonly used metric of socioeconomic disadvantage as measured by zipcode. [24][25][26][27] In this study, ADIs were split into quintiles. [1][2][3][4] Procedural characteristics included surgeon experience, preoperative narcotic use, use of a tubular retractor system, duration of surgery, intraoperative cerebrospinal fluid leak, use of a surgical drain, revision surgery at the same site, procedure day, and time of operation.…”