Length of Stay Beyond Medical Readiness in a Neurosurgical Patient Population and Associated Healthcare Costs

Abstract

BACKGROUND Length of stay beyond medical readiness (LOS-BMR) leads to increased expenses and higher morbidity related to hospital-acquired conditions. OBJECTIVE To determine the proportion of admitted neurosurgical patients who have LOS-BMR and associated risk factors and costs. METHODS We performed a prospective, cohort analysis of all neurosurgical patients admitted to our institution over 5 mo. LOS-BMR was assessed daily by the attending neurosurgeon and neuro-intensivist with a standardized criterion. Univariate and multivariate logistic regressions were performed. RESULTS Of the 884 patients admitted, 229 (25.9%) had a LOS-BMR. The average LOS-BMR was 2.7 ± 3.1 d at an average daily cost of $9 148.28 ± $12 983.10, which resulted in a total cost of $2 076 659.32 over the 5-mo period. Patients with LOS-BMR were significantly more likely to be older and to have hemiplegia, dementia, liver disease, renal disease, and diabetes mellitus. Patients with a LOS-BMR were significantly more likely to be discharged to a subacute rehabilitation/skilled nursing facility (40.2% vs 4.1%) or an acute/inpatient rehabilitation facility (22.7% vs 1.7%, P < .0001). Patients with Medicare insurance were more likely to have a LOS-BMR, whereas patients with private insurance were less likely (P = .048). CONCLUSION The most common reason for LOS-BMR was inefficient discharge of patients to rehabilitation and nursing facilities secondary to unavailability of beds at discharge locations, insurance clearance delays, and family-related issues.

The risk analysis index demonstrates superior discriminative ability in predicting extended length of stay in pituitary adenoma resection patients when compared to the 5-point modified frailty index

“…The significant finding of the RAI predicting eLOS in this patient population is imperative, as eLOS is associated with higher risk of hospital acquired conditions, postoperative complications, healthcare resource utilization, and delayed recovery. 23 Prior studies have shown the average length of stay for PA resection to be between 1 and 4 days, 24 with one study citing 4 days as eLOS, 25 therefore the results of our study further exemplify the significance of using frailty scoring within this patient population, specifically the RAI. The results of our study align with previous reports which show frailty is a significant predictor of worse outcomes in patients undergoing pituitary surgery.…”

Temporal trends in neurosurgical volume and length of stay in a public healthcare system: A decade in review with a focus on the COVID-19 pandemic

“…[ 9 ] However, controversy exists as evidence also shows that older patients are the patient cohort with the greatest likelihood of having an unnecessarily extended LOS when they were otherwise fit for discharge. [ 11 ] In addition, elderly patients are also the age-group with the greatest number of comorbidities, which significantly fluctuates on a patient-to-patient basis. Moreover, extended LOS is influenced by capacity at discharge locations and other socioeconomic factors, such as family circumstances and transportation availability.…”

Letter: Length of Stay Beyond Medical Readiness in a Neurosurgical Patient Population and Associated Healthcare Costs

“…Furthermore, the importance of using resources in neurosurgery more economically has been made apparent during the ongoing COVID-19 pandemic. [5][6][7][8] The release of the study by Linzey et al 9 (published in Neurosurgery 88: E259-E264, March 2021), which explored causes of and solutions for excessive hospital stay in neurosurgery, comes at a time when this topic is more closely examined and widely discussed. According to the study findings, the most common causes of prolonged length of stay beyond medical readiness are inadequate rehabilitation and care facilities for postoperative patients, delays in insurance payments to healthcare providers, and family problems.…”