Factors associated with length of stay after single-level posterior thoracolumbar instrumented fusion primarily for degenerative spondylolisthesis
Open Access
- 10 February 2021
- journal article
- Published by Scientific Scholar in Surgical Neurology International
- Vol. 12, 48
- https://doi.org/10.25259/sni_954_2020
Abstract
Background: The postoperative length of stay (LOS) is an important prognostic indicator for patients undergoing instrumented spinal fusion surgery. Increased LOS can be associated with higher infection rates, higher incidence of venous thromboembolisms, and a greater frequency of hospital-acquired delirium. The day of surgery and early postoperative mobilization following single-level posterior thoracolumbar stabilizations may impact the LOS. In this study, we evaluated the effects of weekday (Monday–Thursday) versus weekend (Friday–Sunday) surgery and postoperative rehabilitation services on LOS following primarily transforaminal lumbar interbody fusion (TLIF) for degenerative spondylolisthesis (DS). Methods: In this single-institution retrospective chart review, we identified 198 adults who received a one-level thoracolumbar instrumented fusion through a posterior only approach (2017–2019). The majority of these patients underwent TLIF for DS. A zero truncated negative binomial model was used for predictors of the primary outcome of LOS (weekday of surgery, duration of operation, first or repeat surgery, and physical therapy/ occupational therapy [PT/OT] evaluation). Covariates were sex, age, and body mass index. Results: We found that operative duration, repeat surgery, and in-hospital PT/OT all significantly increased the LOS (P < 0.05). Furthermore, those undergoing weekday surgery (Monday–Thursday) had 1.29 times longer LOS than those on the weekend (Friday–Sunday), but this did not reach statistical significance (P = 0.09). Conclusion: In our patient sample, duration, repeat surgery, and in-hospital PT/OT increased the LOS following primarily TLIF for DS. The increased LOS in these cases is likely due to higher overall disease burden and case complexity. In addition, those patients with a greater likelihood of extended recovery and ongoing neurologic deficits are more likely to have PT/OT evaluations. Notably, LOS was not significantly impacted by the day of surgery at our institution.Keywords
This publication has 11 references indexed in Scilit:
- Magnitude and modifiers of the weekend effect in hospital admissions: a systematic review and meta-analysisBMJ Open, 2019
- Is Length of Stay Influenced by the Weekday On Which Lumbar Surgery is Performed?Neurosurgery, 2018
- Does Day of Surgery Affect Hospital Length of Stay and Charges Following Minimally Invasive Transforaminal Lumbar Interbody Fusion?Clinical Spine Surgery: A Spine Publication, 2018
- Factors affecting length of stay after elective posterior lumbar spine surgery: a multivariate analysisThe Spine Journal, 2015
- Using the ACS-NSQIP to Identify Factors Affecting Hospital Length of Stay After Elective Posterior Lumbar FusionSpine, 2014
- A review article on the benefits of early mobilization following spinal surgery and other medical/surgical proceduresSurgical Neurology International, 2014
- Day of week of procedure and 30 day mortality for elective surgery: retrospective analysis of hospital episode statisticsBMJ, 2013
- Effect of Immediate Postoperative Physical Therapy on Length of Stay for Total Joint Arthroplasty PatientsThe Journal of Arthroplasty, 2012
- Prehabilitation and early rehabilitation after spinal surgery: randomized clinical trialClinical Rehabilitation, 2010
- Mortality among Patients Admitted to Hospitals on Weekends as Compared with WeekdaysThe New England Journal of Medicine, 2001