General Session: Lumbar
Presented by: R. Guyer - View Audio/Video Presentation (Members Only)
R. Guyer(1), E. Putney(2), D. Ohnmeiss(2), J. Zigler(1)
(1) Texas Back Institute, Plano, TX, United States
(2) Texas Back Institute Research Foundation, Plano, TX, United States
Introduction: Spine surgery is currently in an era of greater focus on reducing costs and also on improving quality metrics such as the readmission rates following surgery. One area impacted by these factors is the length of hospital stay following surgery. The purpose of this study was to investigate factors related to the length of hospital stay following lumbar anterior/posterior combined fusion.
Methods: A spine surgery log used for quality assurance was reviewed to identify all patients who underwent lumbar 360 fusion at one or 2 levels during an eight month period at a single short-term stay hospital (generally treat patients with fewer general health risk factors for complications). Patients undergoing additional procedures (such as osteotomy, instrumentation removal) were excluded. Surgeries were performed for painful degenerative conditions unresponsive to nonoperative care. Length of stay data were analyzed for 72 patients.
Results: Among the 72 patients, 40.3% were discharged post-op day 1 (POD 1), 51.4% were discharged on POD 2, and 8.3% were in the hospital >3 nights. Two patients (2.8%) were readmitted, both for treatment of wound infection. Two additional patients visited the emergency room and were discharged home (one for upper respiratory infection and the other for low grade fever and tachycardia). Other early post-operative problems included one of each of the following: Doppler for possible DVT assessment, nausea, nausea and constipation, pain control (5 day stay) and possible Bells palsy and suicidal ideation (patient discharged to rehabilitation after 8 day LOS). A stepwise regression analysis was performed to determine if factors related to length of stay could be identified. Operative time was significantly related to LOS, none of the other factors included in the analysis were significant including age, gender, body mass index, albumin level, smoking status, diabetes, number of levels operated, and ASA score (a general health status assessment). In this series there were no dural tears, blood transfusions, and no drains were used.
Discussion: Only 8.3% of patients were in the hospital 3 or more days following 1-or 2-level lumbar 360 fusion and only 2 were readmitted, both for infection. The only factor identified related to length of stay was operative time. There appears to be no detrimental effect, or high readmission rate associated with discharging lumbar 360 fusion patients on POD 1 or 2 in appropriately selected patients. It is important to educate patients and their home care provider on appropriate activities, wound care, and signs of complications.