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  • Factors Associated with Complications and Length of Stay Following Multilevel Lumbar Laminectomy and Fusion

    Final Number:
    1157

    Authors:
    Stephen Kyle Mendenhall BS; Jesse E Bible MD; Patrick David Kelly BS; Priya Sivasubramaniam BS; David Shau B.S.; Matthew J. McGirt MD; Clinton J. Devin MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: There is a paucity of data examining patient characteristics that affect surgical complication rates and length of hospital stay for patients undergoing multilevel lumbar laminectomy and fusion.

    Methods: 508 patients undergoing lumbar laminectomy and fusion in 3 or fewer levels were prospectively included in this study. Length of hospital stay and presence/type of a postoperative complication within 30/90-days postoperatively were collected in a comprehensive spine registry. Logistic regression analyses for 30/90-day complications were performed using age, gender, BMI, ASA grade, comorbidities (smoker, diabetes, coronary artery disease), preoperative patient reported outcome scores (preoperative ZUNG depression rating, preoperative MSPQ anxiety measure, preoperative EQ5D, and preoperative ODI) and surgical factors (blood loss, length of surgery, primary vs. revision surgery, use of an interbody fusion, number of levels fused) as covariates. Linear regression analysis for length of hospital stay also included complications occurring during the initial hospital stay as a covariate.

    Results: There was a 12.4% and 15.9% rate of 30 and 90-day complications in this cohort, respectively. Only diabetes was significantly associated with the incidence of 30 and 90-day complications (OR 2.057, 95% CI 1.031-4.101, p = 0.041 & OR 1.970, 95% CI 1.015-3.856, p = 0.045, respectively) after controlling for all other covariates. Increasing length of stay was seen in those with complications during the initial hospital stay (3.025, p = 0.001), increased age (correlation coefficient 0.017, p = 0.044),and increasing number of levels fused (0.325, p = 0.018).

    Conclusions: Our study suggests that diabetes is significantly associated with increased 30 and 90-day complications in patients undergoing lumbar laminectomy and fusion. Increased length of stay was noted in older patients, multilevel fusions, and those that sustained an in hospital complication. Future studies on the role of pre, peri, and post-operative glucose control may elucidate management strategies to reduce complication rates in these patients.

    Patient Care: Improving perioperative complications and optimizing length of stay (LOS) is becoming increasingly important as our health care system moves to become more cost-efficient. Through treatment strategies to better control glucose in the pre, peri, and post-operative period, we may be able to drive down complication rate, improve patient outcomes, and further decrease the cost-burden on our healthcare system. Similarly, we can reduce costs through strategies to decrease in hospital complications, leading to reduced LOS.

    Learning Objectives: This abstract shows that diabetes is significantly associated with increased 30 and 90-day complications. Additionally, we also find that older patients, those undergoing multilevel fusions, and those that sustain an in hospital complication have increased length of hospital stay.

    References:

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