General Session: MIS - Hall F
Presented by: B. Mayo
B. Khechen(1), B. Haws(1), F. Hijji(1), A. Narain(1), B. Mayo(1), D. Massel(1), J. Guntin(1), K. Cardinal(1), K. Singh(1)
(1) Rush University Medical Center, Orthopaedic Surgery, Chicago, IL, United States
Background information: Anterior cervical discectomy and fusion (ACDF) is a common procedure that entails either same-day discharge or a brief inpatient stay. With an increasing focus on cost reduction, limiting the number of overnight stays has become a primary focus for hospitals and physicians alike. Demographic, comorbidity, and procedural risk factors for an overnight stay following ACDF have not been well described in the literature.
Objective: To describe the risk factors for an overnight stay following ACDF.
Methods: A prospectively maintained surgical database of patients who underwent a primary, one- or two-level ACDF for degenerative spinal pathology between 2012-2015 was reviewed. Both bivariate and stepwise multivariate Poisson regression with robust error variance adjusted for patient demographics and preoperative characteristics were used to assess risk factors for an overnight stay.
Results: A total of 98 patients were included in this analysis. On bivariate regression, workers' compensation (RR=1.40, 95% CI=1.04-1.88, p=0.027) and diabetes mellitus (RR=1.40, 95% CI=1.00-1.94, p=0.049) were both found to be associated with an overnight stay. On multivariate stepwise regression, obesity (RR=1.41, 95% CI=1.05-1.90, p=0.024), workers' compensation (RR=1.37, 95% CI=1.00-1.88, p=0.048), and a surgery start time after 9:00 am (RR=1.49, 95% CI = 1.09-2.03, p=0.013) were found to be independently associated with an overnight stay.
Conclusions: The results of this study suggest that workers' compensation, obesity, and a surgery start time after 9:00 am are independently associated with an overnight stay following ACDF. As such, obese patients and those with workers' compensation may be scheduled later in the day to allow for those without additional risk factors to have the highest probability of being discharged on the day of surgery.