Introduction: Paradoxically in an era of increasing emphasis on cost control, relatively little attention has been focused toward the impact of comorbidity upon the length of hospital stay (LOS) following elective spine surgery – despite the insightful utility of such a nonsubjective marker.
Methods: To assess such issues, 182 patients receiving elective lumbar decompression and fusion procedures between July 2011 and March 2013 were retrospectively reviewed. 26 comorbidity variables were assessed in a scaled and existential fashion - obesity, cardiac diseases, paralysis and additional neurologic disease, dyslipidemia, hypertension, peripheral artery disease, anemia and bleeding disorders, pulmonary diseases, diabetes and endocrine disorders, hepatic and renal dysfunctions, chronic gastrointestinal diseases, co-existing neoplasm, arthritis or connective tissue diseases, smoking, drug, or alcohol abuse, psychiatric problems, cerebrovascular compromise, dementia, immune deficiency, vitamin deficiency. Using the resulting data, a novile reaction system was used to assess both the impact of individual comorbidity and the cumulative effect of comorbidities.
Results: The LOS ranged from 1.9 to 24.9 days (M=5.6, SD=3.6) while individual patient scores were between 1 and 30 out of a possible total of 112. Only three comorbidities showed a significantly higher prevalence in those patients who had a mean stay of 1 standard deviation above the mean length of stay – presence of gastrointestinal disease (P=0.005), morbid obesity (P=0.019), and sleep apnea (P=0.033).
In regards to composite comorbidity scores, a breakpoint was 17. One third of patients scored more than that score and stayed for 1.6 days longer than those with lower scores (P=0.005).
Conclusions: The assessment of preoperative comorbidity upon elective spine surgery shows important effects which offer insight into payment arrangements, hospital utilization, and possible increased preemptive correction of the most troublesome comorbidities.
Patient Care: It helps establishing a comprehensive scale to assess patients health before surgery. It also recommend that each comorbidity, even minor ones, needs to be managed, and the patient should be fully optimized before any elective surgery.
Learning Objectives: To assess the impact of having comorbidity on the aggregate costs.