Lightning Podiums: Cervical Degenerative - Room 802A

Presented by: B. Khechen

Author(s):

B. Khechen(1), B. Haws(1), F. Hijji(1), A. Narain(1), J. Guntin(1), K. Cardinal(1), K. Singh(1)

(1) Rush University Medical Center, Orthopaedic Surgery, Chicago, IL, United States

Abstract

Introduction: Length of hospital stay can be a significant driver for healthcare costs following spine procedures. In order to reduce the economic impact of excessive and unnecessary costs, risk factors for increased length of stay must be identified. Previous literature has demonstrated that surgeries performed later in the week can affect the length of stay and costs following joint arthroplasty. These differences have been attributed to reductions in hospital staff and work efficiency on weekends. However, few investigations regarding the day of surgery have been performed in the spine literature. The present study attempts to identify the association between day of surgery on length of stay and hospital charges following anterior cervical discectomy and fusion (ACDF) procedures.

Methods: A prospectively maintained surgical database of patients that underwent primary, 1-2 level ACDF for degenerative spinal pathology between 2008-2015 was reviewed. Patients were stratified into those receiving ACDF early in the week (Monday/Tuesday) or late in the week (Thursday/Friday). Differences in patient demographics and preoperative characteristics were compared between cohorts using chi-square analysis or student's t-test for categorical and continuous variables, respectively. Direct hospital costs were obtained utilizing hospital charges for each procedure and the subsequent care prior to discharge. Associations between date of surgery, length of stay (LOS) and costs were assessed using multivariate linear regression or Poisson regression. Multivariate analyses were controlled for preoperative demographic and operative characteristics.

Results: A total of 522 patients were included in the analyses; of these, 295 (56.5%) were in the early surgery cohort and 227 (43.4%) were in the late surgery cohort. There were no differences in demographic or comorbidity variables between the two cohorts (p>0.05). There were no differences in operative time, estimated blood loss, number of operative levels, or hospital LOS between cohorts (p>0.05). Upon final multivariate analysis, there was no difference in total direct costs or specific cost categories between cohorts (p>0.05).

Conclusion: Patients undergoing ACDF later in the week exhibit similar lengths of stay and hospital costs compared to those undergoing ACDF early in the week. These results suggest that outpatient procedures with short postoperative stays are likely not affected by the changes in hospital work efficiency that occur during the transition to the weekend. As such, hospitals should not restrict minor procedures to specific days of the week. Further assessment of spinal procedures that require longer inpatient stays and the involvement of more hospital staff, such as physical therapists, is necessary to elucidate the effect of surgery date on hospital costs and patient length of stay.

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