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Predicting prolonged length of stay in patients undergoing transforaminal lumbar interbody fusion

  • Original Article - Spine degenerative
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

With growing emphasis on high-value care, many institutions have been working on improving surgical efficiency, quality, and complication reduction. Unfortunately, data are limited regarding perioperative factors that may influence length of stay (LOS) following transforaminal lumbar interbody fusion (TLIF). We sought to design a predictive algorithm that determined patients at risk of prolonged LOS after TLIF. The goal was to identify patients who would benefit from preoperative intervention aimed to reduce LOS.

Methods

We conducted a review of perioperative data for patients who underwent TLIF between 2014 and 2019. Univariate and multivariate stepwise regression models were used to analyze risk factor effects on postoperative LOS.

Results

Two hundred and sixty-nine patients were identified (57.2% women). Mean age at surgery was 61.7 ± 12.3 years. Mean postoperative LOS was 3.08 ± 1.54 days. In multivariate analysis, American Society of Anesthesiologists class (odds ratio [OR] = 1.441, 95% confidence interval [CI] 1.321–1.571), preoperative functional status (OR = 1.237, 95% CI 1.122–1.364), Oswestry Disability Index (OR = 1.010, 95% CI 1.004–1.016), and estimated blood loss (OR = 1.050, 95% CI 1.003–1.101) were independent risk factors for postoperative LOS ≥ 5 days. The final model had an area under the curve of 0.948 with good discrimination and was implemented in the form of an online calculator (https://spine.shinyapps.io/TLIF_LOS/).

Conclusion

The prediction tool derived can be useful for assessing likelihood of prolonged LOS in patients undergoing TLIF. With external validation, this calculator may ultimately assist healthcare providers in identifying patients at risk for prolonged hospitalization so preoperative interventions can be undertaken to reduce LOS, thus reducing resource utilization.

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Data availability

Data that support the findings of this study are available from the corresponding author on reasonable request.

Abbreviations

ALIF:

Anterior lumbar interbody fusion

ASA:

American Society of Anesthesiologists

AUC:

Area under the curve

BMI:

Body mass index

CCI:

Charlson Comorbidity Index

CCP:

Clinical care pathway

CI:

Confidence interval

EBL:

Estimated blood loss

FIM:

Functional Independence Measure

ICD-10:

International Classification of Disease, Tenth Revision

LOS:

Length of stay

mL:

Milliliter(s)

MCS:

Mental component score

ODI:

Oswestry Disability Index

PCS:

Physical component score

PLIF:

Posterior lumbar interbody fusion

ROC:

Receiver operating characteristic

SF-12:

12-Item Short Form Survey

TLIF:

Transforaminal lumbar interbody fusion

VAS:

Visual analog scale

VIF:

Variance inflation factors

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Author information

Authors and Affiliations

  1. Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA

    Cathleen C. Kuo

  2. Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Suite B4, Buffalo, NY, 14203, USA

    Ryan M. Hess, Mohamed A. R. Soliman, Asham Khan, John Pollina & Jeffrey P. Mullin

  3. Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, NY, USA

    Ryan M. Hess, Asham Khan, John Pollina & Jeffrey P. Mullin

  4. Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt

    Mohamed A. R. Soliman

Authors
  1. Cathleen C. Kuo
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  2. Ryan M. Hess
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  3. Mohamed A. R. Soliman
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  4. Asham Khan
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  5. John Pollina
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  6. Jeffrey P. Mullin
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Contributions

Conception and design: RMH, CCK. Acquisition of the data: CCK. Analysis and interpretation of the data: all authors. Drafting the manuscript: RMH, CCK, MARS. Critically revising the manuscript: all authors. Reviewed submitted version of manuscript: all authors.

Corresponding author

Correspondence to Jeffrey P. Mullin.

Ethics declarations

Ethics approval

The following 7 facilities participated in this study: Buffalo General Medical Center, Buffalo, New York; Erie County Medical Center, Buffalo, New York; Gates Vascular Institute, Buffalo, New York; Kenmore Mercy Hospital, Buffalo, New York; Millard Fillmore Suburban Hospital, Williamsville, New York; Niagara Falls Memorial Medical Center, Niagara Falls, New York; and Sisters of Charity Hospital, Buffalo, New York.

The study was approved by the University at Buffalo Institutional Review Board (STUDY000037).

At the time of hospital admission, informed consent for patient information to be published was provided by each patient or a legally authorized representative.

Consent was obtained from patients or a legally authorized representative before procedures were performed.

Conflict of interest

CCK, RMH, MARS: None.

AK: Research grant from the Scoliosis Research Society to study scoliosis in Chiari patients.

JPM: Research funding from AOSpine North America (AOSNA) and the Research Committee Award #87639; and from Medtronic External Research Program Health Professionals, ERP ID#2020–12271.

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Kuo, C.C., Hess, R.M., Soliman, M.A.R. et al. Predicting prolonged length of stay in patients undergoing transforaminal lumbar interbody fusion. Acta Neurochir 164, 2655–2665 (2022). https://doi.org/10.1007/s00701-022-05334-3

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  • DOI: https://doi.org/10.1007/s00701-022-05334-3

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