Introduction: Extended length of stay (LOS) represents a potential target to contain cost and improve the value of spine care. Therefore, understanding factors associated with extended LOS is vital. As many healthcare systems have fewer assets available around weekends, the patients operated on later in the workweek might have longer LOS. Here we analyze the effect of day of surgery on LOS after spine surgery.
Methods: Patients undergoing surgery for lumbar degenerative disease were prospectively enrolled in the multicenter QOD registry. Patients with LOS 0 and those operated on weekends were excluded. Multivariable proportional odds model was built for LOS. Separate analysis was performed to determine the effect of weekday on LOS by procedure. Patients were stratified into treatment groups based on fusion vs. decompression alone. A cutoff point was determined based on median LOS to create a dichotomous LOS outcome variable, which was used to build logistic regression models.
Results: A total of 11,897 patients were analyzed. Of those, 5781(48.6%) patients underwent fusion surgery. The median LOS was 2 days. In multivariate analysis, there was no significant effect of admission day on LOS for all patients, patients undergoing decompression alone and elderly patients. The odds of having longer LOS was higher with a Thursday or Friday admission in patients undergoing fusion surgery (OR:1.3,p<0.0001) and for those discharged to facility (OR:1.4,p<0.0001). For “Decompression and Fusion” group (cutoff point: LOS 3 day) Wednesday (OR:1.359,p=0.002), Thursday (OR:1.478,p<0.001), and Friday (OR:1.446,p=0.001) admission days had significantly higher chance of a LOS greater than 3 days than Monday.
Conclusions: We demonstrate that in select patient subsets, day of surgery appears to be a significant contributor to extended LOS. This observation represents an opportunity for prospective quality improvement by either modifying day of surgery for specific patients or ensuring that adequate placement resources are available to assist peri-weekend discharges.
Patient Care: The results of this study provides an opportunity for quality improvement by modifying the day of surgery for patients undergoing fusion surgery or those requiring discharge to facility. When performed onperi-weekend days; optimal pre-planning regarding placement resources might help in reducing LOS for these sub-groups of patients.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the variation in length of stay for different subgroups of patients undergoing lumbar spine surgery, 2) Understand the impact of day of surgery on extended length of stay.