Predictors of Hospital Length of Stay and 30-Day Readmission in Cervical Spondylotic Myelopathy Patients: An Analysis of 3057 Patients Using the ACS-NSQIP Database

Peter G. Passias, Cyrus M. Jalai, Nancy Worley, Shaleen Vira, Saqib Hasan, Samantha R. Horn, Frank A. Segreto, Cole A. Bortz, Andrew P. White, Michael Gerling, Virginie LaFage, Thomas Errico

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

Background Hospital length of stay (LOS), 30-day readmission rate, and other metrics are increasingly being used to evaluate quality of surgical care. The factors most relevant to cervical spondylotic myelopathy (CSM) are not yet established. Objective To identify perioperative factors associated with extended LOS and 30-day readmission following elective surgery for CSM. Methods Surgical CSM patients at institutions represented by the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) during 2010–2012 were included. Patients with fracture, 9 or more levels fused, or cancer were excluded. Extended LOS was defined as 75th percentile of the cohort. Univariate analysis and multivariate logistic regression identified predictors for extended LOS, 30-day readmission, and reoperation. Linear regression modeling was used to evaluate variables. Results Three thousand fifty-seven surgical CSM cases were isolated. Age (odds ratio [OR], 1.496), diabetes (OR, 1.691), American Society of Anesthesiologists (ASA) class (OR, 2.081), posterior surgical approach (OR, 2.695), and operative time (OR, 1.008) were all positive predictors (P < 0.05) for extended LOS (≥4 days). Thirty-two percent of the cohort (976 patients) had 30-day readmission data. Among these, 915 patients were not readmitted (93.8%), while 61 (6.2%) were readmitted. Diabetes (OR, 1.460) and ASA class (OR, 2.539) were significant positive predictors for hospital readmission. Age (OR, 0.918) was a negative predictor of re-operation in readmitted patients, and pulmonary comorbidities (OR, 4.584) were a positive predictor (P < 0.05). Conclusions Patients with diabetes and higher ASA class were at increased risk for extended LOS and readmission within 30-days. Patients with increased operative time have greater risk for extended LOS. Preoperative pulmonary comorbidities increased reoperation risk, whereas increased age reduced the risk. Attention to these factors may benefit CSM patients.

Original languageEnglish (US)
Pages (from-to)e450-e458
JournalWorld neurosurgery
Volume110
DOIs
StatePublished - Feb 2018
Externally publishedYes

Keywords

  • ACS-NSQIP Database
  • Cervical spondylotic myelopathy
  • Length of stay
  • Myelopathy
  • Readmission

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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    Passias, P. G., Jalai, C. M., Worley, N., Vira, S., Hasan, S., Horn, S. R., Segreto, F. A., Bortz, C. A., White, A. P., Gerling, M., LaFage, V., & Errico, T. (2018). Predictors of Hospital Length of Stay and 30-Day Readmission in Cervical Spondylotic Myelopathy Patients: An Analysis of 3057 Patients Using the ACS-NSQIP Database. World neurosurgery, 110, e450-e458. https://doi.org/10.1016/j.wneu.2017.11.009