Variations in LOS and its main determinants overtime at an academic spinal care center from 2006–2019

Abstract

Objectives Efforts to safely reduce hospital LOS while maintaining quality outcomes and patient satisfaction are paramount. The primary goal of this study was to assess trends in LOS at a high-volume quaternary care spine center. Secondary goals were to assess trends in factors most associated with prolonged LOS. Methods This is a prospective study of all consecutive patients admitted from January 2006 to December 2019. Data included demographics, diagnostic category (degenerative, oncology, deformity, trauma, other), LOS (mean, median, interquartile range, standard deviation, defined as days from admission to discharge), and in-hospital adverse events. Results A total of 13,493 patients were included. Overall LOS has not changed over time with an overall median of 6.3 days ( p = 0.451). Median LOS significantly increased for patients treated for degenerative pathology from 2.2 days in 2006 to 3.2 days in 2019 ( p = 0.019). LOS has not changed for patients treated for deformity (overall median 6.8 days, p = 0.411), oncology (overall median 11.0 days, p = 0.051), or trauma (overall median 11.8 days, p = 0.582). Emergency admissions increased 3.2%/year for degenerative pathologies ( p = < 0.001). Mean age has increased from 48.4 years in 2006 to 58.1 years in 2019 ( p = < 0.001). This trend was observed in the deformity, degenerative and trauma group, not for patients treated for oncological disease. More adverse events were significantly associated with increasing age. Conclusion This is the first North American study to comprehensively analyze trends in LOS for spinal surgery overtime in an academic center. Overall, LOS has not changed from 2006–2019. Various factors that influence LOS appear to have balanced each other. It may also be explained by the changing epidemiology of both elective and emergency surgeries. These findings provide opportunities for intervention and improvement, targeted at the geriatric population, to reduce length of hospitalization.

Factors contributing to a longer length of stay in adults admitted to a quaternary spinal care center

“…Patient consent was not required by our institutional ethics board as all patients have anonymized data collected prospectively in our study registry. Our study is a follow-up of our previously published work using the same patient population and dataset [ 16 ], however further analyzing factors impacting LOS that were previously not investigated to better understand why certain trends were observed in LOS over time.…”

“…We have previously examined the trends of LOS over time at our institution [ 16 ], finding that the overall median LOS has not significantly changed over time between 2006 and 2019, while mean age has increased during this time. Additionally, in patients with degenerative pathology in particular, median LOS did increase over this period as well as the proportion of emergency admissions in this diagnostic group [ 16 ]. These results led us to thoroughly examine the specific factors that affected LOS among the same patient population as a follow-up study of our previously published work.…”

Cost-Utility Analysis of Sacroiliac Joint Fusion in High-Risk Patients Undergoing Multi-Level Lumbar Fusion to the Sacrum

“…Over the past decade, the aging population has led to additional spinal surgeries, with a high correlation between increasing age and more adverse events. 41 Concurrently, infection prevention protocols and technological advances have contributed to a reduction in adverse events, such as surgical site infections, resulting in a reduction in hospital length of stay (LOS) and associated costs. 1,41 Conversely, technological advances in implants as well as surgical navigation systems with intra-operative 3D imaging have likely increased the cost of care.…”

“…41 Concurrently, infection prevention protocols and technological advances have contributed to a reduction in adverse events, such as surgical site infections, resulting in a reduction in hospital length of stay (LOS) and associated costs. 1,41 Conversely, technological advances in implants as well as surgical navigation systems with intra-operative 3D imaging have likely increased the cost of care. Based on a prospective study of patients who underwent spinal surgery from 2006 to 2019, Charlotte et al concluded that, in aggregate, these various factors that influence LOS (and associated costs) appear to have had the net effect of balancing each other out, further supporting the use of these previously published health insurance claims data analyses to inform costs.…”

“…Based on a prospective study of patients who underwent spinal surgery from 2006 to 2019, Charlotte et al concluded that, in aggregate, these various factors that influence LOS (and associated costs) appear to have had the net effect of balancing each other out, further supporting the use of these previously published health insurance claims data analyses to inform costs. 41 Another limitation is that patients who underwent SIJF following index treatment failure did not incur additional time in the severe SIJ pain health state for post-surgical recovery; also, patients with severe SIJ pain did not incur costs associated with lost productivity. Despite these exclusions, our approach is conservative in that the results are biased in favor of index treatment with MLF alone, given that such patients are more likely to experience severe post-operative SIJ pain and undergo a subsequent SIJF with associated lost productivity, compared to index treatment with MLF + SIJF.…”