Predicting prolonged length of stay in patients undergoing transforaminal lumbar interbody fusion
- 4 August 2022
- journal article
- research article
- Published by Springer Science and Business Media LLC in Acta Neurochirurgica
- Vol. 164 (10), 2655-2665
- https://doi.org/10.1007/s00701-022-05334-3
Abstract
Background With growing emphasis on high-value care, many institutions have been working on improving surgical efficiency, quality, and complication reduction. Unfortunately, data are limited regarding perioperative factors that may influence length of stay (LOS) following transforaminal lumbar interbody fusion (TLIF). We sought to design a predictive algorithm that determined patients at risk of prolonged LOS after TLIF. The goal was to identify patients who would benefit from preoperative intervention aimed to reduce LOS. Methods We conducted a review of perioperative data for patients who underwent TLIF between 2014 and 2019. Univariate and multivariate stepwise regression models were used to analyze risk factor effects on postoperative LOS. Results Two hundred and sixty-nine patients were identified (57.2% women). Mean age at surgery was 61.7 ± 12.3 years. Mean postoperative LOS was 3.08 ± 1.54 days. In multivariate analysis, American Society of Anesthesiologists class (odds ratio [OR] = 1.441, 95% confidence interval [CI] 1.321–1.571), preoperative functional status (OR = 1.237, 95% CI 1.122–1.364), Oswestry Disability Index (OR = 1.010, 95% CI 1.004–1.016), and estimated blood loss (OR = 1.050, 95% CI 1.003–1.101) were independent risk factors for postoperative LOS ≥ 5 days. The final model had an area under the curve of 0.948 with good discrimination and was implemented in the form of an online calculator (https://spine.shinyapps.io/TLIF_LOS/). Conclusion The prediction tool derived can be useful for assessing likelihood of prolonged LOS in patients undergoing TLIF. With external validation, this calculator may ultimately assist healthcare providers in identifying patients at risk for prolonged hospitalization so preoperative interventions can be undertaken to reduce LOS, thus reducing resource utilization.Keywords
This publication has 29 references indexed in Scilit:
- Factors affecting length of stay after elective posterior lumbar spine surgery: a multivariate analysisThe Spine Journal, 2015
- Comparison of complications, costs, and length of stay of three different lumbar interbody fusion techniques: an analysis of the Nationwide Inpatient Sample databaseThe Spine Journal, 2014
- Predictive Factors of Hospital Stay in Patients Undergoing Minimally Invasive Transforaminal Lumbar Interbody Fusion and InstrumentationSpine, 2012
- Device-associated infection rates and extra length of stay in an intensive care unit of a university hospital in Wroclaw, Poland: International Nosocomial Infection Control Consortium's (INICC) findingsJournal of Critical Care, 2012
- A Multimodal Clinical Pathway Can Reduce Length of Stay After Total Knee ArthroplastyHSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery, 2010
- Effect of Fibrin Sealant on Drain Output and Duration of Hospitalization After Multilevel Anterior Cervical FusionSpine, 2008
- 1997 Volvo Award Winner in Clinical StudiesSpine, 1997
- PERFORMANCE PROFILES OF THE FUNCTIONAL INDEPENDENCE MEASUREAmerican Journal of Physical Medicine & Rehabilitation, 1993
- A new method of classifying prognostic comorbidity in longitudinal studies: Development and validationJournal of Chronic Diseases, 1987
- A new look at the statistical model identificationIEEE Transactions on Automatic Control, 1974