Introduction: Patient length of stay (LOS) is a concern following adult deformity surgery (ADS) and identifying risk factors may optimize perioperative care. Few studies have identified consistent risk factors that may help in limiting hospital LOS following ADS using a large database. Our objective was to analyze factors associated with an increased LOS following ADS.
Methods: This was a retrospective analysis of prospectively collected data from the NSQIP database of patients > 18 years old undergoing ADS between 2005 and 2012. Patient baseline factors, perioperative data, preoperative labs, and post-operative course were recorded. Complications and mortality were analyzed using multivariate logistic regression analysis with significance defined as p < 0.05. Odds ratio (OR) was calculated with a 95% confidence interval.
Results: 4,793 patients were identified with 19 deaths (0.4%). 54% of patients were female and the average age was 57.1 +/- 13.8 years. 48% underwent posterior fusion with overall mean LOS 3.98 days (4.77). Patient factors associated with increased LOS were age >65, diabetes, dependent functional status prior to surgery, PVD, neuromuscular injury, prior stroke, recent weight loss, bleeding disorder, ASA > 3. Operative factors associated with increased LOS were operative time > 4 hours, osteotomies, and fusion to pelvis, while LOS following primary and revision anterior procedures was significantly shorter (p<0.001).
Conclusions: Specific patient factors and operative variables were independent risk factors for prolonged LOS following ADS. Shorter LOS were noted following primary and revision anterior procedures. These findings may be used to minimize extended LOS and postoperative complications following ADS.
Patient Care: By anticipating factors associated with increased length of stay after ADS, providers can attempt to identify these factors before surgery to better care for the patients after surgery.
Learning Objectives: The aim of this investigation was to analyze factors associated with an increased LOS following ADS.