Patient, clinical, surgical, and institutional factors associated with length of stay in scheduled degenerative thoracolumbar spine surgery: National Multicenter Cohort Analysis from the Canadian Spine Outcomes and Research Network

Author:

Dandurand Charlotte1,Mashayekhi Mohammad S.1,McIntosh Greg2,Street John T.1,Fisher Charles G.1,Finkelstein Joel3,Abraham Edward4,Paquet Jérôme5,Hall Hamilton6,Wai Eugene7,Fourney Daryl R.8,Bailey Christopher S.9,Christie Sean D.4,Soroceanu Alex10,Johnson Michael11,Kelly Adrienne12,Marion Travis E.13,Nataraj Andrew14,Santaguida Carlo15,Warren Daniel16,Hogan Thomas Guy17,Manson Neil18,Phan Philippe7,Ahn Henry6,Rampersaud Y. Raja19,Blanchard Jocelyn20,Thomas Kenneth10,Dea Nicolas1,Charest-Morin Raphaële1

Affiliation:

1. Combined Neurosurgical and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia;

2. Canadian Spine Outcomes and Research Network, Canadian Spine Society, Markdale, Ontario;

3. Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario;

4. Department of Surgery, Dalhousie University, Halifax, Nova Scotia;

5. Centre Hospitalier Universitaire de Québec, Hôpital Enfant-Jésus, Québec City, Québec;

6. Department of Surgery, University of Toronto, Ontario;

7. Department of Surgery, Ottawa Hospital, Ottawa, Ontario;

8. Department of Surgery, University of Saskatchewan, Saskatoon, Saskatchewan;

9. London Health Sciences Centre, Combined Neurosurgical and Orthopaedic Spine Program, Western University, London, Ontario;

10. Department of Surgery, University of Calgary, Alberta;

11. Winnipeg Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba;

12. Department of Surgery, Northern Ontario School of Medicine, Sault Ste. Marie, Ontario;

13. Department of Surgery, Thunder Bay Regional Health Science Centre, Thunder Bay, Ontario;

14. Department of Surgery, University of Alberta Hospital, Edmonton, Alberta;

15. Department of Surgery, McGill University, Montréal, Québec;

16. Department of Neurosurgery, Vancouver Island Health Authority, Victoria, British Columbia; and

17. Department of Orthopaedic Surgery, Health Sciences Centre, St. John’s, Newfoundland and Labrador, Canada

18. Department of Surgery, Canada East Spine Centre, Saint John, New Brunswick;

19. University Health Network, Toronto Western Hospital, Toronto, Ontario;

20. Department of Surgery, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec;

Abstract

OBJECTIVE Length of stay (LOS) is a contributor to costs and resource utilization. The primary goal of this study was to identify patient, clinical, surgical, and institutional variables that influence LOS after elective surgery for thoracolumbar degenerative pathology. The secondary objective was to examine variability in LOS and institutional strategies used to decrease LOS. METHODS This is a retrospective study of prospectively collected data from a multicentric cohort enrolled in the Canadian Spine Outcomes and Research Network (CSORN) between January 2015 and October 2020 who underwent elective thoracolumbar surgery (discectomy [1 or 2 levels], laminectomy [1 or 2 levels], and posterior instrumented fusion [up to 5 levels]). Prolonged LOS was defined as LOS greater than the median. Logistic regression models were used to determine factors associated with prolonged LOS for each procedure. A survey was sent to the principal investigators of the participating healthcare institutions to understand institutional practices that are used to decrease LOS. RESULTS A total of 3700 patients were included (967 discectomies, 1094 laminectomies, and 1639 fusions). The median LOSs for discectomy, laminectomy, and fusion were 0.0 (IQR 1.0), 1.0 (IQR 2.0), and 4.0 (IQR 2.0) days, respectively. On multivariable analysis, predictors of prolonged LOS for discectomy were having more leg pain, higher Oswestry Disability Index (ODI) scores, symptom duration more than 2 years, having undergone an open procedure, occurrence of an adverse event (AE), and treatment at an institution without protocols to reduce LOS (p < 0.05). Predictors of prolonged LOS for laminectomy were increased age, living alone, higher ODI scores, higher BMI, open procedures, longer operative time, AEs, and treatment at an institution without protocols to reduce LOS (p < 0.05). For posterior instrumented fusion, predictors of prolonged LOS were older age, living alone, more comorbidities, higher ODI scores, longer operative time, AEs, and treatment at an institution without protocols to reduce LOS (p < 0.05). The laminectomy group had the largest variability in LOS (SD 4.4 days, range 0–133 days). Three hundred fifty-four patients (22%) had an LOS above the 75th percentile. Ten institutions (53%) had either Enhanced Recovery After Surgery or standardized protocols in place. CONCLUSIONS Among the factors identified in this study, worse baseline ODI scores, experiencing AEs, and treatment at an institution without protocols aimed at reducing LOS were predictive of prolonged LOS in all surgical groups. The laminectomy group had the largest variability in LOS.

Publisher

Journal of Neurosurgery Publishing Group (JNSPG)

Subject

General Medicine

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5. Low back pain: a call for action;Buchbinder R,2018

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