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Preoperative predictors of prolonged hospitalization in patients undergoing lateral lumbar interbody fusion

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Abstract

Purpose

We aim to examine the preoperative factors associated with increased postoperative length of stay in patients undergoing LLIF in the hospital setting.

Methods

Patient demographics, perioperative characteristics, and patient-reported outcome measures (PROMs) were collected from a single-surgeon database. Patients undergoing LLIF in the hospital setting were separated into postoperative LOS <48 h (H) and LOS ≥ 48H. Univariate analysis for preoperative characteristics was utilized to determine covariates for multivariable logistic regression. Multivariable logistic regression was then utilized to determine significant predictors of extended postoperative length of stay. Secondary univariate analysis of inpatient complications, operative, and postoperative characteristics were calculated to determine postoperative factors associated with prolonged hospitalization.

Results

Two-hundred and forty patients were identified with 115 patients’ LOS ≥ 48H. Univariate analysis identified age/Charlson Comorbidity Index (CCI) score/gender/insurance type/number of contiguous fused levels/preoperative PROMs of Visual Analog Scale (VAS) back/VAS leg/Patient-Reported Outcomes Measurement Information System (PROMIS-PF)/Oswestry Disability Index (ODI)/degenerative spondylolisthesis diagnoses/foraminal stenosis/central stenosis for multivariable logistic regression. Multivariable logistic regression calculated significant positive predictors of LOS ≥ 48H to be age/3-level fusion/preoperative ODI scores. Negative predictors of LOS ≥ 48H were the diagnosis of foraminal stenosis/preoperative PROMIS-PF/male gender. The secondary analysis determined that patients with longer operative time/estimated blood loss/transfusion/postoperative day 0 and 1 pain and narcotic consumption/complications of altered mental status/postoperative anemia/fever/ileus/urinary retention were associated with prolonged hospitalization.

Conclusion

Older patients undergoing LLIF with greater preoperative disability and 3-level fusion were more likely to require prolonged hospitalization. Male patients with higher preoperative physical function and who were diagnosed with foraminal stenosis were less likely to require prolonged hospitalization.

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Abbreviations

ACDF:

anterior cervical discectomy and fusion

ALIF:

anterior lumbar interbody fusion

ASA:

American Society of Anesthesiologists

ASC:

ambulatory surgical centers

BMI:

body mass index

CCI:

Charlson Comorbidity Index

DOS:

duration of symptoms

EBL:

estimated blood loss

H:

hours

LLIF:

lateral lumbar interbody fusion

LOS:

length of stay

MCS:

mental component score

MCID:

minimum clinically important difference

MIS:

minimally invasive

OR:

odds ratio

PCS:

physical component score

PLIF:

posterior lumbar interbody fusion

POD:

postoperative day

ODI:

Oswestry Disability Index

OME:

oral morphine equivalents

PHQ-9:

Patient Health Questionnaire-9

PROMs:

Patient-reported Outcome Measures

PROMIS-PF:

Patient-reported Outcome Measurement Information System Physical Function

SF-12:

12-item Short Form

TLIF:

transforaminal lumbar interbody fusion

VAS:

visual analog scale

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA

    James W. Nie, Timothy J. Hartman, Keith R. MacGregor, Omolabake O. Oyetayo, Eileen Zheng, Vincent P. Federico, Dustin H. Massel, Arash J. Sayari & Kern Singh

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Correspondence to Kern Singh.

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Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Review Board (IRB) of Rush University Medical Center (ORA #14051301).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

Kern Singh, MD, receives royalties from Zimmer Biomet, Stryker, RTI Surgical, Lippincott Williams and Wilkins, Thieme, Jaypee Publishing, and Slack Publishing. Kern Singh, MD, owns stock in Avaz Surgical LLC and Vital 5 LLC. Kern Singh, MD, holds a consulting position with Zimmer Biomet and K2M. Kern Singh, MD, holds board membership with Vital 5 LLC. Kern Singh, MD, is on the editorial board of Contemporary Spine Surgery. Kern Singh, MD, received a research grant from the Cervical Spine Research Society.

Kern Singh, MD, holds board membership with TDi LLC and Minimally Invasive Spine Study Group and receives no compensation as a board member. Kern Singh, MD, is on the editorial board of Orthopedics Today and Vertebral Columns and receives no compensation as a member of the editorial board. Kern Singh, MD, is on the board of directors of Cervical Spine Research Society, International Society for the Advancements of Spine Surgery, and American Academy of Orthopaedic Surgeons and receives no compensation as a member of the board of directors.

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Nie, J.W., Hartman, T.J., MacGregor, K.R. et al. Preoperative predictors of prolonged hospitalization in patients undergoing lateral lumbar interbody fusion. Acta Neurochir 165, 2615–2624 (2023). https://doi.org/10.1007/s00701-023-05648-w

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