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Non-medical factors significantly influence the length of hospital stay after surgery for degenerative spine disorders

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Abstract

Background

Unnecessarily long hospital stays are costly and inefficient. Studies have shown that the length of hospital stay (LOS) for spine surgical procedures is influenced by various disease-related or medical factors, but few have examined the role of socio-demographic/socio-economic (SDE) factors.

Methods

This was a retrospective analysis of data from 10,770 patients (5056 men, 5714 women; 62 ± 15 years) with degenerative spinal disorders, collected prospectively in an in-house database within the framework of EUROSPINE’s Spine Tango Registry. Surgeons completed the Tango surgery form (clinical history, demographics, surgical measures, complications), and patients, a baseline Core Outcome Measures Index. Stepwise linear regression analyses examined SDE predictors of LOS, controlling for potential medical/biological factors.

Results

The mean LOS was 7.9 ± 5.2 days. The final model accounted for 42% of variance in LOS, with SDE variables explaining 13% variance and medical/surgical predictors, 29%. In the final model, the SDE factors age and being female were significant independent predictors of LOS, whereas others were either non-significant (insurance status, being of Swiss nationality, being a smoker) or reached only borderline significance (p < 0.1) (BMI). Controlling for all other SDE and medical/surgical confounders, being female was associated with 1.11-day longer LOS (95% CI 0.96–1.27; p < 0.0001).

Conclusions

Patients of advanced age and female gender are at increased risk of longer hospital stay after surgery for degenerative spinal disorders. Further studies should seek to understand the reasoning behind the gender disparity, in order to minimise potentially unnecessary costs of prolonged LOS. Targeted preoperative discharge planning may improve the utilisation of hospital resources.

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Fig. 1

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Notes

  1. Calculation of this score was only possible for the data collected since 2012 (see earlier), and therefore the model is based on a smaller, more recent sub-sample of patients (n = 5,409) (Fig. 1).

References

  1. Pumberger M, Chiu Y-L, Ma Y et al (2012) National in-hospital morbidity and mortality trends after lumbar fusion surgery between 1998 and 2008. J Bone Joint Surg Br 94-B:359–364. https://doi.org/10.1302/0301-620x.94b3.27825

    Article  Google Scholar 

  2. Sivasubramaniam V, Patel HC, Ozdemir BA, Papadopoulos MC (2015) Trends in hospital admissions and surgical procedures for degenerative lumbar spine disease in England: a 15-year time-series study. BMJ Open 5:1–7. https://doi.org/10.1136/bmjopen-2015-009011

    Article  Google Scholar 

  3. MedlinePlus Medical Encyclopedia (2013) Health care financing trends. Health Care Financ Rev 9:127–132

    Google Scholar 

  4. Mirza SK, Deyo RA, Heagerty PJ et al (2008) Development of an index to characterize the “invasiveness” of spine surgery. Spine (Phila Pa 1976) 33:2651–2661. https://doi.org/10.1097/brs.0b013e31818dad07

    Article  Google Scholar 

  5. Alosh H, Li D, Riley LH, Skolasky RL (2015) Health care burden of anterior cervical spine surgery. J Spinal Disord Tech 28:5–11. https://doi.org/10.1097/bsd.0000000000000001

    Article  PubMed  Google Scholar 

  6. Saltzman BM, Basques B, Leroux T et al (2018) The influence of gender on early adverse events, hospital charges and length of stay after shoulder arthroplasty. Int Orthop 42:149–155. https://doi.org/10.1007/s00264-017-3547-6

    Article  PubMed  Google Scholar 

  7. Arnold M, Rice LR, Anderson KK et al (2011) Factors affecting hospital length of stay following anterior cervical discectomy and fusion. Evid Based Spine-Care J 2:11–18

    Article  Google Scholar 

  8. Basques BA, Fu MC, Buerba RA et al (2014) Using the ACS-NSQIP to identify factors affecting hospital length of stay after elective posterior lumbar fusion. Spine (Phila Pa 1976) 39:497–502. https://doi.org/10.1097/BRS.0000000000000184

    Article  Google Scholar 

  9. Sultan AA, Berger RJ, Cantrell WA et al (2019) Predictors of extended length of hospital stay in adolescent idiopathic scoliosis patients undergoing posterior segmental instrumented fusion. Spine (Phila Pa 1976) 44:715–722. https://doi.org/10.1097/BRS.0000000000002919

    Article  Google Scholar 

  10. Mannion AF, Porchet F, Kleinstück FS et al (2009) The quality of spine surgery from the patient’s perspective. Part 1: the core outcome measures index in clinical practice. Eur Spine J 18:367–373. https://doi.org/10.1007/s00586-009-0942-8

    Article  PubMed  PubMed Central  Google Scholar 

  11. De Cassai A, Boscolo A, Tonetti T et al (2019) Assignment of ASA-physical status relates to anesthesiologists’ experience: a survey-based national-study. Korean J Anesthesiol 72:53–59. https://doi.org/10.4097/kja.d.18.00224

    Article  PubMed  Google Scholar 

  12. Bjorgul K, Novicoff WM, Saleh KJ (2010) American society of anesthesiologist physical status score may be used as a comorbidity index in hip fracture surgery. J Arthroplasty 25:134–137. https://doi.org/10.1016/j.arth.2010.04.010

    Article  PubMed  Google Scholar 

  13. Nie H, Hao J, Peng C, Ou Y (2013) Clinical outcomes of discectomy in octogenarian patients with lumbar disc herniation. Clin Spine Surg 26:74–78

    Google Scholar 

  14. Zheng F, Cammisa FP, Sandhu HS et al (2002) Factors predicting hospital stay, operative time, blood loss, and transfusion in patients undergoing revision posterior lumbar spine decompression, fusion, and segmental instrumentation. Spine (Phila Pa 1976) 27:818–824

    Article  Google Scholar 

  15. Gruskay JA, Fu M, Basques BA et al (2016) Factors affecting length of stay and complications after elective anterior cervical discectomy and fusion national surgical quality improvement project database (ACS NSQIP). J Spinal Disord Tech 29:34–42

    Google Scholar 

  16. Dunn JC, Lanzi J, Kusnezov N et al (2015) Predictors of length of stay after elective total shoulder arthroplasty in the United States. J Shoulder Elb Surg 24:754–759. https://doi.org/10.1016/j.jse.2014.11.042

    Article  Google Scholar 

  17. Husted H, Holm G, Jacobsen S (2008) Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients. Acta Orthop 79:168–173. https://doi.org/10.1080/17453670710014941

    Article  PubMed  Google Scholar 

  18. Herren C, Aghayev E, Kaulhausen T et al (2014) Einflussfaktoren auf die Verweildauer in der WirbelsäulenchirurgieInfluencing factors on the length of stay in lumbar spine surgery. Orthopade 43:1043–1051. https://doi.org/10.1007/s00132-014-3033-4

    Article  CAS  PubMed  Google Scholar 

  19. Heyer JH, Cao N, Amdur RL, Rao RR (2019) Postoperative complications following orthopedic spine surgery: Is there a difference between men and women? Int J Spine Surg 13:6017. https://doi.org/10.14444/6017

    Article  Google Scholar 

  20. Shelton W, Moore CD, Socaris S et al (2010) The effect of a family support intervention on family satisfaction, length-of-stay, and cost of care in the intensive care unit. Crit Care Med 38:1315–1320. https://doi.org/10.1097/CCM.0b013e3181d9d9fe

    Article  PubMed  Google Scholar 

  21. Pochon L, Kleinstück FS, Porchet F, Mannion AF (2016) Influence of gender on patient-oriented outcomes in spine surgery. Eur Spine J 25:235–246. https://doi.org/10.1007/s00586-015-4062-3

    Article  CAS  PubMed  Google Scholar 

  22. Porchet F, Lattig F, Grob D et al (2010) Comparison of patient and surgeon ratings of outcome 12 months after spine surgery. J Neurosurg Spine 12:447–455. https://doi.org/10.3171/2009.11.spine09526

    Article  PubMed  Google Scholar 

  23. Walid MS, Robinson ECM, Robinson JS (2011) Higher comorbidity rates in unemployed patients may significantly impact the cost of spine surgery. J Clin Neurosci 18:640–644. https://doi.org/10.1016/j.jocn.2010.08.029

    Article  PubMed  Google Scholar 

  24. Gonçalves-Bradley DC, Lannin NA, Clemson LM et al (2016) Discharge planning from hospital (review) summary of findings for the main comparison. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD000313.pub5.www.cochranelibrary.com

    Article  PubMed  PubMed Central  Google Scholar 

  25. Kalanithi PA, Arrigo R, Boakye M (2012) Morbid obesity increases cost and complication rates in spinal arthrodesis. Spine (Phila Pa 1976) 37:982–988. https://doi.org/10.1097/BRS.0b013e31823bbeef

    Article  Google Scholar 

  26. Seicean A, Seicean S, Alan N et al (2013) Effect of smoking on the perioperative outcomes of patients who undergo elective spine surgery. Spine (Phila Pa 1976) 38:1294–1302. https://doi.org/10.1097/BRS.0b013e31828e2747

    Article  Google Scholar 

  27. Kulinskaya E, Kornbrot D, Gao H (2005) Length of stay as a performance indicator: robust statistical methodology. IMA J Manag Math 16:369–381. https://doi.org/10.1093/imaman/dpi015

    Article  Google Scholar 

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Authors and Affiliations

  1. Spine Center, Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland

    D. Mai, D. Haschtmann, T. Pirvu, T. F. Fekete & A. F. Mannion

  2. SwissRDL, Institute of Social and Preventive Medicine (ISPM), University of Berne, Mittelstrasse 43, 3012, Bern, Switzerland

    D. Mai & C. Brand

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  1. D. Mai
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Mai, D., Brand, C., Haschtmann, D. et al. Non-medical factors significantly influence the length of hospital stay after surgery for degenerative spine disorders. Eur Spine J 29, 203–212 (2020). https://doi.org/10.1007/s00586-019-06209-5

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  • DOI: https://doi.org/10.1007/s00586-019-06209-5

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