Preoperative Factors Affecting Length of Stay After Elective Anterior Cervical Discectomy and Fusion With and Without Corpectomy

Abstract

Study Design Retrospective cohort study of 183 patients who underwent elective anterior cervical discectomy and fusion (ACDF) at a single institution over a two-year period. Objective To determine which preoperative factors were independently associated with a prolonged hospital length of stay (LOS) following ACDF. Summary of Background Data ACDF has become the most common treatment modality for addressing cervical spine pathology. Extended LOS following ACDF is associated with increased costs and complications. There is a lack of conclusive data for factors affecting LOS after ACDF. This study aims to create a multivariate model to determine the association of various patient and operative characteristics with LOS after ACDF. Methods Patients who underwent elective ACDF at a single academic institution between January 2011 and February 2013 were identified using billing records. Their charts were reviewed to collect variables available preoperatively such as patient demographics, comorbidities, and surgery planned. Patients were categorized as normal or extended LOS, with extended LOS defined as LOS > 75th percentile. A multivariate logistic regression was used to determine which factors were independently associated with extended LOS. Results A total of 183 ACDF patients were identified. The average LOS for this cohort was 2.0 ± 2.5 days (Mean ± Standard Deviation). Extended LOS was defined as ≥ 3 days. Multivariate analysis revealed that preoperative factors independently associated with extended LOS were history of non-spinal malignancy (Odds Ratio [OR] = 4.9), history of pulmonary disease (OR = 4.0), and procedures that included corpectomy (OR = 4.5). Conclusion Patients with a history of non-spinal malignancy or pulmonary disease, as well as patients who underwent corpectomy, were more likely to have an extended LOS (ORs 4.0–4.9). Of significant note, other factors that one might expect to be associated with extended LOS did not independently predict extended LOS in this analysis.

Outpatient Anterior Cervical Discectomy and Fusion: An Analysis of Readmissions from the New Jersey State Ambulatory Services Database

“…Another important limitation is the lack of granularity in the SASD to perform an analysis of comorbidities and other factors previously shown to be associated with longer LOS in ACDF. 20 A sixth limitation is the fact that more than 24% of patients who received outpatient ACDF did not have readmission data; it is possible that these patients may have suffered more severe postoperative complications than the 76% of patients who did have readmission data. A seventh limitation is that given the outpatient nature of this database, potential complications which occurred following discharge that did not involve a patient being readmitted may have not been included; for instance, a patient discharged from an ambulatory center who subsequently died at home without having been readmitted may not have been included as a mortality in the SASD.…”

Does the Day of the Week Affect Length of Stay and Hospital Charges Following Anterior Cervical Discectomy and Fusion?

“…13,14 This transition has contributed to an increased effort to identify costsaving measures in spine surgery. 14 While numerous studies have demonstrated patient and perioperative characteristics that influence LOS, 11,[15][16][17][18][19] a paucity of literature exists regarding the effect of surgical scheduling on LOS and direct medical costs following ACDF. As such, the current study aimed to investigate if a day of surgery was associated with greater LOS and direct hospital costs following primary, level 1-2 ACDF.…”

“…[7][8][9][10] Although previous studies have analyzed factors affecting length of stay (LOS) after spinal surgery, few investigations regarding the effect of day of surgery have been performed. 11,12 The purpose of this study is to identify any differences in length of hospital stay and costs between patients who underwent anterior cervical discectomy and fusion (ACDF) procedures earlier in the week compared to those who had the procedure later in the week.…”

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

“…Investigators have identified numerous preoperative factors that increase the chances of a prolonged LOS, including advanced age [ 9 - 10 ], ASA score > 2 [ 9 - 11 ], higher BMI [ 10 ], gender, opioid use [ 12 ], intraoperative complications [ 13 - 15 ], and postoperative complications. These include cardiac, urinary, and pulmonary complications [ 13 , 16 - 17 ]. Intraoperative factors adversely affecting LOS included extended operative time [ 18 ], blood transfusions [ 9 , 19 ], adverse complications [ 20 ], and fibrin and drain use [ 21 ].…”