Extended Length of Stay in Elderly Patients After Lumbar Decompression and Fusion Surgery May Not Be Attributable to Baseline Illness Severity or Postoperative Complications

Owoicho Adogwa, Shyam A. Desai, Victoria D. Vuong, Daniel T. Lilly, Bichun Ouyang, Mark Davison, Syed Khalid, Carlos A. Bagley, Joseph Cheng

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Hospital leaders are seeking ways to improve resource utilization and minimize long postoperative hospital stays. Common explanations for extended length of stay (LOS) are baseline patient illness, postoperative complications, and physician practice differences. The degree to which extended LOS represents illness severity or postoperative complications is unknown. We investigated influence of postoperative complications and patient comorbidities on extended LOS after lumbar spine surgery in elderly patients. Methods: This retrospective cohort study from 2008 to 2014 analyzed data from the American College of Surgeons National Surgical Quality Improvement Program for elderly patients undergoing lumbar spine surgery. Patient demographics, comorbidities, LOS, and complications were recorded. Multivariable logistic regression analysis was used to determine odds ratio for risk-adjusted LOS. Primary outcome was the degree extended LOS represented patient illness or postoperative complications. Results: Of 9482 patients, 1909 (20.13%) had extended LOS. A few patients with extended LOS had a history of relevant comorbidities, including diabetes (21.76%), chronic obstructive pulmonary disease (8.17%), congestive heart failure (0.94%), myocardial infarction (0%), acute renal failure (0.47%), and stroke (2.23%). Of patients with normal LOS, 93% had no complications, 5.19% had 1 complication, and 1.69% had >1 complication. Among patients with extended LOS, 73.65% had no complications, 18.96% had 1 complication, and 7.39% had >1 complication (P < 0.000). Conclusions: Our study suggests that much of the variation in LOS for elderly patients undergoing lumbar spine surgery is not attributable to baseline patient illness or postoperative complications and most likely represents differences in practice style or surgeon preference.

Original languageEnglish (US)
JournalWorld Neurosurgery
DOIs
StateAccepted/In press - Jan 1 2018

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Decompression
Length of Stay
Comorbidity
Spine
Quality Improvement
Acute Kidney Injury
Chronic Obstructive Pulmonary Disease
Cohort Studies
Heart Failure
Retrospective Studies
Logistic Models
Stroke
Odds Ratio
Myocardial Infarction
Regression Analysis
Demography
Physicians

Keywords

  • Elderly
  • Enhanced recovery pathway
  • Length of stay
  • Lumbar fusion
  • Postoperative complications
  • Spine surgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Extended Length of Stay in Elderly Patients After Lumbar Decompression and Fusion Surgery May Not Be Attributable to Baseline Illness Severity or Postoperative Complications. / Adogwa, Owoicho; Desai, Shyam A.; Vuong, Victoria D.; Lilly, Daniel T.; Ouyang, Bichun; Davison, Mark; Khalid, Syed; Bagley, Carlos A.; Cheng, Joseph.

In: World Neurosurgery, 01.01.2018.

Research output: Contribution to journalArticle

Adogwa, Owoicho ; Desai, Shyam A. ; Vuong, Victoria D. ; Lilly, Daniel T. ; Ouyang, Bichun ; Davison, Mark ; Khalid, Syed ; Bagley, Carlos A. ; Cheng, Joseph. / Extended Length of Stay in Elderly Patients After Lumbar Decompression and Fusion Surgery May Not Be Attributable to Baseline Illness Severity or Postoperative Complications. In: World Neurosurgery. 2018.
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abstract = "Background: Hospital leaders are seeking ways to improve resource utilization and minimize long postoperative hospital stays. Common explanations for extended length of stay (LOS) are baseline patient illness, postoperative complications, and physician practice differences. The degree to which extended LOS represents illness severity or postoperative complications is unknown. We investigated influence of postoperative complications and patient comorbidities on extended LOS after lumbar spine surgery in elderly patients. Methods: This retrospective cohort study from 2008 to 2014 analyzed data from the American College of Surgeons National Surgical Quality Improvement Program for elderly patients undergoing lumbar spine surgery. Patient demographics, comorbidities, LOS, and complications were recorded. Multivariable logistic regression analysis was used to determine odds ratio for risk-adjusted LOS. Primary outcome was the degree extended LOS represented patient illness or postoperative complications. Results: Of 9482 patients, 1909 (20.13{\%}) had extended LOS. A few patients with extended LOS had a history of relevant comorbidities, including diabetes (21.76{\%}), chronic obstructive pulmonary disease (8.17{\%}), congestive heart failure (0.94{\%}), myocardial infarction (0{\%}), acute renal failure (0.47{\%}), and stroke (2.23{\%}). Of patients with normal LOS, 93{\%} had no complications, 5.19{\%} had 1 complication, and 1.69{\%} had >1 complication. Among patients with extended LOS, 73.65{\%} had no complications, 18.96{\%} had 1 complication, and 7.39{\%} had >1 complication (P < 0.000). Conclusions: Our study suggests that much of the variation in LOS for elderly patients undergoing lumbar spine surgery is not attributable to baseline patient illness or postoperative complications and most likely represents differences in practice style or surgeon preference.",
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AU - Adogwa, Owoicho

AU - Desai, Shyam A.

AU - Vuong, Victoria D.

AU - Lilly, Daniel T.

AU - Ouyang, Bichun

AU - Davison, Mark

AU - Khalid, Syed

AU - Bagley, Carlos A.

AU - Cheng, Joseph

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Hospital leaders are seeking ways to improve resource utilization and minimize long postoperative hospital stays. Common explanations for extended length of stay (LOS) are baseline patient illness, postoperative complications, and physician practice differences. The degree to which extended LOS represents illness severity or postoperative complications is unknown. We investigated influence of postoperative complications and patient comorbidities on extended LOS after lumbar spine surgery in elderly patients. Methods: This retrospective cohort study from 2008 to 2014 analyzed data from the American College of Surgeons National Surgical Quality Improvement Program for elderly patients undergoing lumbar spine surgery. Patient demographics, comorbidities, LOS, and complications were recorded. Multivariable logistic regression analysis was used to determine odds ratio for risk-adjusted LOS. Primary outcome was the degree extended LOS represented patient illness or postoperative complications. Results: Of 9482 patients, 1909 (20.13%) had extended LOS. A few patients with extended LOS had a history of relevant comorbidities, including diabetes (21.76%), chronic obstructive pulmonary disease (8.17%), congestive heart failure (0.94%), myocardial infarction (0%), acute renal failure (0.47%), and stroke (2.23%). Of patients with normal LOS, 93% had no complications, 5.19% had 1 complication, and 1.69% had >1 complication. Among patients with extended LOS, 73.65% had no complications, 18.96% had 1 complication, and 7.39% had >1 complication (P < 0.000). Conclusions: Our study suggests that much of the variation in LOS for elderly patients undergoing lumbar spine surgery is not attributable to baseline patient illness or postoperative complications and most likely represents differences in practice style or surgeon preference.

AB - Background: Hospital leaders are seeking ways to improve resource utilization and minimize long postoperative hospital stays. Common explanations for extended length of stay (LOS) are baseline patient illness, postoperative complications, and physician practice differences. The degree to which extended LOS represents illness severity or postoperative complications is unknown. We investigated influence of postoperative complications and patient comorbidities on extended LOS after lumbar spine surgery in elderly patients. Methods: This retrospective cohort study from 2008 to 2014 analyzed data from the American College of Surgeons National Surgical Quality Improvement Program for elderly patients undergoing lumbar spine surgery. Patient demographics, comorbidities, LOS, and complications were recorded. Multivariable logistic regression analysis was used to determine odds ratio for risk-adjusted LOS. Primary outcome was the degree extended LOS represented patient illness or postoperative complications. Results: Of 9482 patients, 1909 (20.13%) had extended LOS. A few patients with extended LOS had a history of relevant comorbidities, including diabetes (21.76%), chronic obstructive pulmonary disease (8.17%), congestive heart failure (0.94%), myocardial infarction (0%), acute renal failure (0.47%), and stroke (2.23%). Of patients with normal LOS, 93% had no complications, 5.19% had 1 complication, and 1.69% had >1 complication. Among patients with extended LOS, 73.65% had no complications, 18.96% had 1 complication, and 7.39% had >1 complication (P < 0.000). Conclusions: Our study suggests that much of the variation in LOS for elderly patients undergoing lumbar spine surgery is not attributable to baseline patient illness or postoperative complications and most likely represents differences in practice style or surgeon preference.

KW - Elderly

KW - Enhanced recovery pathway

KW - Length of stay

KW - Lumbar fusion

KW - Postoperative complications

KW - Spine surgery

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SN - 1878-8750

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