Introduction: The notion of higher complication rate and mortality in emergency surgeries is well established. There is a paucity of literature demonstrating the impact of emergent versus elective admissions for spinal surgery on the perioperative outcomes and dynamics of resource utilization. We aim to evaluate the influence of the type of admission (elective or emergent) and day of surgery (within the emergent group) on the incidence and pattern of perioperative complications in the patients undergoing lumbar fusion.
Methods: Data was obtained from the Nationwide Inpatient Sample (NIS) database between 2002 and 2011. The patients undergoing lumbar fusion were identified by using International Classification of Diseases - Ninth Revision (ICD-9) procedure codes. Study groups (‘admission’ and ‘day of surgery’) were compared on the basis of patient characteristics, comorbid risk factors, procedure, hospital related findings, perioperative complications and resource utilization. Discharge disposition, LOS, length of stay (LOS) and total hospital charges were the measures of resource utilization.
Results: A total of 266439 patients were identified, who underwent lumbar fusion between 2002 and 2011 for degenerative pathologies. The majority of the admissions were elective (n = 224372, 92.6%). Emergent admission comprised 7.4% (n = 18046) of the admission. In the emergent group, the majority of the procedures performed on the same day (n = 13223, 74.9%) and the remaining patients were operated on the other days (n = 4429, 25.1%). Emergent admission was found to be an independent risk factor for the higher incidence of genitourinary complications, DVT, PE and blood transfusions. The mean total hospital charges were higher in the emergent admission and ‘other days’ surgery groups (84353 vs 80660, P<0.001 and 79813 vs 107092, P<0.001).
Conclusions: Emergent admission’ and surgery performed on the ‘other days' in lumbar fusion are independent risk factors for the higher incidence of perioperative complications, greater LOS and mean total hospital charges.
Patient Care: This study will help the clinician to understand the patient characteristic and pattern of the complication rates in the patients who are admitted on an emergent basis for the lumbar fusion.
Learning Objectives: 1. This study will help the clinicians to understand the common pattern of perioperative complications in the patients undergoing emergent lumbar fusion.
2. This study will also be useful to the health care administrators to develop an appropriate resource allocation strategy.