Introduction: Neurosurgical procedures encompass a wide variety of pathologies. The care of hospitalized patients has become more costly over the past two decades. We reviewed the national trends of hospital length of stay (LOS) for elective inpatient neurosurgical procedures from 1988 to 2011. We sought to confirm that LOS is decreasing and whether the trends continue to decline or reached a plateau.

Methods: The Nationwide Inpatient Sample (NIS) data represent a twenty-percent stratified sample of U.S. community (non-federal) hospitals. The NIS (1988 to 2011) provided data on patients hospitalized who underwent an elective neurosurgical principal procedure as defined by the Healthcare Cost and Utilization Project Clinical Classification Software (CCS) definitions (diagnostic codes in CCS complete procedure categories 1-9, 51, 59, 158, and partial 11, 12, 56, and 61).

Results: We identified 2,788,763 relevant elective hospital admissions of 237 selected neurosurgical procedures. In 1988, the overall mean LOS for all procedures combined was 7.2 days, decreasing to 3.0 days in 2011 (Figure 1). A selected subset of cranial (craniotomy for meningioma, craniotomy for aneurysm, ventricular shunt) and spinal (laminectomy, discectomy, and anterior cervical fusion) procedures demonstrated similar declines over the twenty-four year period and reached a relative plateau from 2000 onward. We also observed similar trends when all admissions, not limited to elective, were analyzed.

Conclusions: The mean LOS over the most recent ten years of available NIS data has been stable for a variety of selected neurosurgical procedures. Important to consider is whether, along with overall neurosurgical care, individual procedures could be targeted for additional declines in LOS despite the apparent plateau in reduced LOS. Eliminating unnecessary hospital days decreases overall cost of care and may reduce nosocomial complications.

Patient Care: The research affirms that health care providers have successfully reduced inpatient length of stay for elective neurosurgical procedures as a whole over a recent twenty-four year period. In addition, selected specific neurosurgical procedures demonstrate the same finding. The research will help clinicians understand whether further reductions in length of stay are feasible or if the mean trends continue to decline.

Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the aggregated trends in means length of stay for all elective neurosurgical procedures. 2) Understand how selected individual procedures’ mean length of stay varies over time. 3) Identify whether decreases in mean length of stay reached a plateau or continue to decline.

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