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Miller EM, Polascik BW, Kitchen ST, Wahbeh EE, Abouhaif TM, Contillo NJ, Elashker AL, Hsia MW, Marsh KA, Thometz KJ, Yin TC, O'Gara TJ. Late-week Multilevel Anterior Cervical Discectomy and Fusion Associated With Increased Length of Stay. Clin Spine Surg 2024; 37:E335-E338. [PMID: 38409673 DOI: 10.1097/bsd.0000000000001590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 01/22/2024] [Indexed: 02/28/2024]
Abstract
STUDY DESIGN Retrospective analysis of clinical data from a single institution. OBJECTIVE To assess the day of surgery during the week as a possible predictor of length of stay (LOS) following anterior cervical discectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA Surgeries later in the week may result in longer LOS and higher costs for joint arthroplasty, yet this is unclear following spine surgery. Procedures performed later in the week may lead to weekend admissions when there are limited services that may contribute to an extended LOS. We attempt to identify associations between day of surgery and LOS, readmission, and complications following single- and multilevel ACDF. MATERIALS AND METHODS Patients at a single institution undergoing ACDF by 7 primary surgeons in both orthopedic and neurosurgery spine departments between 2015 and 2019 were retrospectively reviewed. Patients were stratified by surgery day at either the beginning (Monday/Tuesday) or end (Thursday/Friday) of the week and by single- or multilevel ACDF. Surgery for trauma, infections, adjacent level disease, or revision were excluded. Patient demographics, Charlson Comorbidity Index (CCI), LOS, postoperative complications, and readmission rates were assessed. RESULTS Six hundred fifty-two patients underwent ACDF. For single-level ACDF, 222 were reviewed, with 112 having surgery at the beginning and 110 at the end of the week. For multilevel ACDF, 431 were reviewed, with 192 having surgery at the beginning and 239 at the end of the week. No differences in pre- or postoperative variables were determined for single-level ACDF. Despite no differences in pre-operative variables, CCI, operative duration, or number of levels, late-week multilevel ACDF had longer average LOS (2.8±3.0 days) compared to early-week surgery (2.0±2.0 days) ( P =0.018). CONCLUSIONS Late-week multilevel ACDF was associated with an increased LOS, as it may prove beneficial to surgical planning. This conflicts with previous reports that day of week was not associated with LOS following ACDF. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Evan M Miller
- Department of Orthopaedic Surgery, Atrium Health Wake Forest Baptist
| | - Bryce W Polascik
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Spencer T Kitchen
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Elias E Wahbeh
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Taylor M Abouhaif
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Nicholas J Contillo
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Adrianna L Elashker
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Michelle W Hsia
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Kathleen A Marsh
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Kyler J Thometz
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Timothy C Yin
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Tadhg J O'Gara
- Department of Orthopaedic Surgery, Atrium Health Wake Forest Baptist
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Hill A, Qosja N, Geldmaker LE, Schommer J, Haehn DA, Wieczorek MA, Thomas CS, Hochwald A, Thiel DD. Association of day of surgery and distance traveled with length of stay in patients undergoing robotic-assisted partial nephrectomy (RAPN) at a tertiary medical center. J Robot Surg 2024; 18:284. [PMID: 39003367 DOI: 10.1007/s11701-024-02039-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 06/30/2024] [Indexed: 07/15/2024]
Abstract
The objective of this study is to analyze the association between surgical day of the week and distance traveled with prolonged length of stay (LOS) following robotic-assisted partial nephrectomy (RAPN). 563 consecutive RAPN performed by a single surgeon were evaluated. Early week RAPN was considered Monday through Wednesday, while late-week RAPN was defined as surgery performed Thursday through Friday. Distance traveled for RAPN was evaluated as greater than or less than 60 miles. The respective groups were compared to see if the surgical day of the week or distance traveled influenced the hospital stay or prolonged hospital stay (defined as hospital length of stay equal or greater than 3 days). Overall, 213 patients (38.0%) undergoing RAPN experienced a prolonged LOS. A total of 380 patients underwent early week RAPN compared to 183 late-week RAPN. Patients undergoing late-week RAPN were more likely to have a prolonged LOS compared to early week RAPN (n = 81, 44% vs. n = 133, 35%, respectively; p = 0.004). 229 patients traveled less than 60 miles, while 332 patients traveled more than 60 miles to receive RAPN. 135 patients (40.7%) traveling more than 60 miles experienced a prolonged stay compared to 78 patients (34.1%) traveling less than 60 miles, although this difference was not statistically significant (p = 0.128). Patients who underwent RAPN at the end of the week were more likely to have a prolonged LOS, while distance traveled for RAPN did not appear to affect likelihood of prolonged LOS.
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Affiliation(s)
- Austin Hill
- Universtiy of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA
| | - Neda Qosja
- Department of Urology, Mayo Clinic, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 2224, USA
| | | | - Jared Schommer
- Department of Urology, Mayo Clinic, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 2224, USA
| | - Daniela A Haehn
- Department of Urology, Mayo Clinic, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 2224, USA
| | - Mikolaj A Wieczorek
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, USA
| | - Colleen S Thomas
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, USA
| | - Alex Hochwald
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, USA
| | - David D Thiel
- Department of Urology, Mayo Clinic, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 2224, USA.
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Johnson AH, Brennan JC, Rana P, Turcotte JJ, Patton C. Does Surgical Day of Week Affect Patient Outcomes and Hospital Costs Following Lumbar Fusion? Cureus 2024; 16:e64571. [PMID: 39144864 PMCID: PMC11323789 DOI: 10.7759/cureus.64571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2024] [Indexed: 08/16/2024] Open
Abstract
Background As the population ages, surgical intervention for degenerative spine conditions is increasing, and this causes a commiserate increase in healthcare expenditures associated with these procedures. Little research has been done on the effect of early-week versus later-week surgeries on patient outcomes, cost, and length of stay (LOS) in patients undergoing lumbar fusion surgery. The purpose of this study is to compare LOS, patient outcomes, and hospital costs between patients having surgery early in the week and later in the week. Methods A retrospective review of 771 patients undergoing a one-, two-, or three-level lumbar fusion from December 2020 to December 2023 at a single institution was performed. Demographics, surgical details, postoperative outcomes and cost were compared between patients who had surgery on Monday, Tuesday, and Wednesday, to those having surgery Thursday or Friday. Univariate and multivariate analyses were performed to compare the groups. Results There were no differences in age, sex, BMI, race, American Society of Anesthesiology (ASA) scores, Charlson Comorbidity Index (CCI) scores, number of operative levels or inpatient/outpatient status between early- and late-week surgeries. Postoperatively the only significant difference was cost, late-week surgeries were, on average, $3,697 more expensive than early-week surgeries ($26,506 vs. $22,809; p<0.001). On multivariate analysis late-week surgeries were 2.47 times more likely to have a non-home discharge (OR: 2.47, 95% CI: 1.24 to 4.95; p=0.010) and 2.19 times more likely to have a 30-day readmission (OR: 2.19, 95% CI:1.01 to 4.74; p=0.044) Additionally, late-week surgeries were $2,041.55 (β:2,041.55, 95% CI: 804.72 to 3,278.38; p=0.001) more expensive than early-week surgeries. Conclusions At our institution, patients undergoing one- to three-level lumbar fusion surgery on Thursday or Friday had a higher risk of non-home discharge, 30-day readmission, and incurred higher cost than those having early-week surgery. Further research is needed to elucidate the reasons for these findings and to evaluate interventions aimed at improving outcomes for patients undergoing surgery later in the week.
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Affiliation(s)
| | - Jane C Brennan
- Orthopedic Research, Anne Arundel Medical Center, Annapolis, USA
| | - Parimal Rana
- Orthopedic Surgery Research, Anne Arundel Medical Center, Annapolis, USA
| | - Justin J Turcotte
- Orthopedic and Surgical Research, Anne Arundel Medical Center, Annapolis, USA
| | - Chad Patton
- Orthopedic Surgery, Anne Arundel Medical Center, Annapolis, USA
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Graham BC, Lucasti C, Scott MM, Baker SC, Vallee EK, Patel DV, Hamill CL. Does Surgical Day of the Week Affect Hospital Course and Outcomes for Patients Undergoing Adult Spinal Deformity Surgery? Global Spine J 2024:21925682241226821. [PMID: 38197607 DOI: 10.1177/21925682241226821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
STUDY DESIGN Retrospective Cohort Analysis. OBJECTIVES Extended hospital length of stay (LOS) poses a significant cost burden to patients undergoing adult spinal deformity (ASD) surgery. The purpose of this study is to investigate the relationship between late-week surgery and LOS in patients undergoing ASD surgery. METHODS 256 patients who underwent ASD surgery between January 2018 and December 2021 by a single fellowship-trained orthopedic spine surgeon comprised the patient sample. Demographics, intraoperative, and perioperative data were collected for the 256 patients who underwent ASD surgery. Patients were divided into two groups based on surgical day of the week: (1) Early-week (Monday/Tuesday) n = 126 and (2) Late-week (Thursday/Friday) n = 130. Descriptive statistics, T-tests, and linear and logistic regression models were used to analyze the data. RESULTS Surgical details and sociodemographic characteristics did not differ between the groups. When controlling for TLIF/DLIF status and PSO status there was no difference in mean length of stay between the groups. The late-week group was associated with a greater risk of 30-day readmission, but there was no difference in complications, infections, or intraoperative complications. CONCLUSIONS We found no difference in mean length of stay between surgeries performed early in the week vs late in the week. Although late-week surgeries had higher 30-day readmission risk, all other outcomes, including complication rates, showed no significant differences. When adequate weekend post-operative care is available, we do not advise restricting ASD surgeries to specific weekdays.
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Affiliation(s)
- Benjamin C Graham
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Christopher Lucasti
- UBMD Orthopaedics and Sports Medicine Doctors of Buffalo, University at Buffalo, Buffalo, NY, USA
| | - Maxwell M Scott
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Seth C Baker
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Emily K Vallee
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Dil V Patel
- UBMD Orthopaedics and Sports Medicine Doctors of Buffalo, University at Buffalo, Buffalo, NY, USA
| | - Christopher L Hamill
- UBMD Orthopaedics and Sports Medicine Doctors of Buffalo, University at Buffalo, Buffalo, NY, USA
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Lundgren ME, Detwiler AN, Lamping JW, Gael SL, Chen NW, Kasir R, Whaley JD, Park DK. Effect of Instrumented Spine Surgery on Length of Stay. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202305000-00016. [PMID: 37186578 DOI: 10.5435/jaaosglobal-d-22-00231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 01/11/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Total joint arthroplasty studies have identified that surgeries that take place later in the week have a longer length of stay compared with those earlier in the week. This has not been demonstrated in studies focused on anterior cervical diskectomy and fusions or minimally invasive lumbar laminectomies. All-inclusive instrumented spine surgeries, however, have not been analyzed. The purpose of this study was to determine whether day of surgery affects length of stay and whether there are predictive patient characteristics that affect length of stay in instrumented spine surgery. METHODS All instrumented spine surgeries in 2019 at a single academic tertiary center were retrospectively reviewed. Patients were categorized for surgical day and discharge disposition to home or a rehabilitation facility. Differences by patient characteristics in length of stay and discharge disposition were compared using Kruskal-Wallis and chi square tests along with multiple comparisons. RESULTS Seven hundred six patients were included in the analysis. Excluding Saturday, there were no differences in length of stay based on the day of surgery. Age older than 75 years, female, American Society of Anesthesiology (ASA) classification of 3 or 4, and an increased Charlson Comorbidity Index were all associated with a notable increase in length of stay. While most of the patients were discharged home, discharge to a rehabilitation facility stayed, on average, 4.7 days longer (6.8 days compared with 2.1 days, on average) and were associated with an age older than 66 years old, an ASA classification of 3 or 4, and a Charlson Comorbidity Index of 1 to 3. CONCLUSIONS Day of surgery does not affect length of stay in instrumented spine surgeries. Discharge to a rehabilitation facility, however, did increase the length of stay as did age older than 75 years, higher ASA classification, and increased Charlson Comorbidity Index classification.
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Affiliation(s)
- Mary E Lundgren
- From the Department of Orthopedic Surgery, William Beaumont Hospital, Royal Oak, MI (Dr. Lundgren, Dr. Detwiler, Dr. Lamping, Dr. Gael, Dr. Kasir, Dr. Whaley, and Dr. Park), and the Beaumont Research Institute, Royal Oak, MI (Dr. Chen)
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Maron SZ, Dan J, Gal JS, Neifert SN, Martini ML, Lamb CD, Genadry L, Rothrock RJ, Steinberger J, Rasouli JJ, Caridi JM. Surgical Start Time Is Not Predictive of Microdiscectomy Outcomes. Clin Spine Surg 2021; 34:E107-E111. [PMID: 33633067 DOI: 10.1097/bsd.0000000000001063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 07/24/2020] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Retrospective analysis of clinical data from a single institution. OBJECTIVE The objective of this study was to assess the time of surgery as a possible predictor for outcomes, length of stay, and cost following microdiscectomy. SUMMARY OF BACKGROUND DATA The volume of microdiscectomy procedures has increased year over year, heightening interest in surgical outcomes. Previous investigations have demonstrated an association between time of procedures and clinical outcomes in various surgeries, however, no study has evaluated its influence on microdiscectomy. METHODS Demographic and outcome variables were collected from all patients that underwent a nonemergent microdiscectomy between 2008 and 2016. Patients were divided into 2 cohorts: those receiving surgery before 2 pm were assigned to the early group and those with procedures beginning after 2 pm were assigned to the late group. Outcomes and patient-level characteristics were compared using bivariate, multivariable logistic, and linear regression models. Adjusted length of stay and cost were coprimary outcomes. Secondary outcomes included operative complications, nonhome discharge, postoperative emergency department visits, or readmission rates. RESULTS Of the 1261 consecutive patients who met the inclusion criteria, 792 were assigned to the late group and 469 were assigned to the early group. There were no significant differences in demographics or baseline characteristics between the 2 cohorts. In the unadjusted analysis, mean length of stay was 1.80 (SD=1.82) days for the early group and 2.00 (SD=1.70) days for the late group (P=0.054). Mean direct cost for the early cohort was $5088 (SD=$4212) and $4986 (SD=$2988) for the late cohort (P=0.65). There was no difference in adjusted length of stay or direct cost. No statistically significant differences were found in operative complications, nonhome discharge, postoperative emergency department visits, or readmission rates between the 2 cohorts. CONCLUSION The study findings suggest that early compared with late surgery is not significantly predictive of surgical outcomes following microdiscectomy.
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Affiliation(s)
| | | | - Jonathan S Gal
- Anesthesia, Perioperative and Pain Medicine, Mount Sinai Hospital, New York, NY
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Afternoon Surgical Start Time Is Associated with Higher Cost and Longer Length of Stay in Posterior Lumbar Fusion. World Neurosurg 2020; 144:e34-e39. [DOI: 10.1016/j.wneu.2020.07.082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/12/2020] [Accepted: 07/13/2020] [Indexed: 02/06/2023]
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