Extended Length of Stay in Elderly Patients after Anterior Cervical Discectomy and Fusion is Not Attributable to Baseline Illness Severity or Post-Operative Complications.

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Extended Length of Stay in Elderly Patients after Anterior Cervical Discectomy and Fusion is Not Attributable to Baseline Illness Severity or Post-Operative Complications.

World Neurosurg. 2018 Apr 21;:

Authors: Adogwa O, Lilly DT, Vuong VD, Desai SA, Ouyang B, Khalid S, Khanna R, Bagley CA, Cheng J

Abstract
BACKGROUND: Healthcare systems are increasing efforts to minimize postoperative hospital stays to improve resource use. Common explanations for extended postoperative stay are baseline patient sickness, postoperative complications, or physician practice differences. However, the degree extended length of stay (LOS) represents patient illness or postoperative complications remains unknown. The aim is to investigate the influence of postoperative complications and elderly patient comorbidities on extended LOS after anterior cervical discectomy and fusion (ACDF).
METHODS: This retrospective study was performed from January 1, 2008-December 31, 2014 on data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Patient demographics, comorbidities, LOS, and inpatient complications were recorded. Multivariable logistic regression analysis was used to determine the odds-ratio for risk-adjusted extended LOS. The primary outcome was the degree extended LOS represented patient illness or postoperative complications.
RESULTS: Of 4,730 participants, 1351 (28.56%) had extended LOS. A minority of patients with extended LOS had a history of relevant comorbidities - diabetes (29.53%), COPD (9.4%), CHF (1.04%), MI (0.33%), or acute renal failure (0.3%), and stroke (5.92%). Among normal LOS patients, 96.8% had no complications, 2.7% had one complication, and 0.5% had greater than one complication. In patients with extended LOS, 79.4% had no complications, 14.5% had one complication, and 6.1% had greater than one complication (p<0.0001).
CONCLUSION: Our study suggests much of LOS variation after an ACDF is not attributable to baseline patient illness or complications and most likely represents differences in practice style or surgeon preference.

PMID: 29689404 [PubMed - as supplied by publisher]

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