General Session: Innovative Technologies I - Hall F

Presented by: J. Guntin

Author(s):

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

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

Abstract

Introduction: Globally, low back pathology results in a significant portion of healthcare expenditure through direct costs from treatment interventions and indirect costs as a result of disability. Furthermore, surgical spine procedures serve as the most expensive intervention on a per-case basis. Identifying factors that increase the cost of spine interventions can assist in reducing healthcare costs and improving the overall value of surgical spine care. Previously, orthopaedic procedures occurring later in the week have been associated with an increased length of stay and consequent increases in costs. However, no such analysis has been performed on common spinal procedures such as lumbar decompressions. As such, the purpose of this study is to determine if there is an association between surgery day and length of stay or hospital costs after primary minimally invasive lumbar decompression (LD).

Methods: Patients that underwent primary, 1-3 level MIS LD were reviewed. Patients undergoing MIS LD were stratified based on the day of surgery; surgery early in the week (Monday/Tuesday) or late in the week (Thursday/Friday). Differences in patient demographics and preoperative characteristics were compared between cohorts. 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 controlled for preoperative demographic and operative characteristics.

Results: A total of 717 patients were included in the analyses. Of these, 420 were in the early surgery cohort and 297 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).

Conclusions: The timing of surgery within the week is not associated with differences in inpatient length of stay or hospital costs following MIS LD. These results suggest that the postoperative care following MIS LD that occurs later in the week is not affected by the reduction in hospital staff or changes in work efficiency that occur during the transition from the weekdays to the weekend. This may be due to the fact that MIS LD is a minor outpatient procedure and does not require a large amount of inpatient resources, staff, or rehabilitation in the immediate postoperative period. As such, hospitals should not alter surgical scheduling patterns to restrict these procedures to certain days within the week.

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