Medical Student University of Illinois College of Medicine Chicago, Illinois, United States
Introduction: Determining preoperative predictors of extended postoperative length of stay (LOS) in the hospital setting may provide insight into preoperative management of expectations and future strategies for cost reduction.
Methods: Patient demographics, perioperative characteristics, and PROMs were collected from a single-surgeon database. Patients undergoing LLIF in the hospital setting were separated into postoperative LOS < 48 hours (H) and LOS≥48H. Univariate analysis for preoperative characteristics was utilized to determine covariates for multivariable logistic regression. Multivariable logistic regression was then utilized to determine significant predictors of extended postoperative length of stay. Secondary univariate analysis of inpatient complications, operative, and postoperative characteristics were calculated to determine postoperative factors associated with prolonged hospitalization.
Results: Two-hundred and forty patients were identified undergoing LLIF procedure with 115 patients’ LOS≥48H. Univariate analysis identified age, Charlson Comorbidity Index (CCI) score, gender, insurance type, number of contiguous fused levels, preoperative PROMs of Visual Analog Scale (VAS) back, VAS leg, Patient-Reported Outcomes Measurement Information System (PROMIS-PF), and Oswestry Disability Index (ODI), and diagnoses of degenerative spondylolisthesis, foraminal stenosis, and central stenosis for multivariable logistic regression. These variables and American Society of Anesthesiologists (ASA) classification were utilized in multivariable logistic regression. Multivariable logistic regression calculated significant positive predictors of LOS≥48H to be age, 3 fused levels, and preoperative ODI scores. Negative predictors of LOS≥48H were the diagnosis of foraminal stenosis, preoperative PROMIS-PF, and male gender. Secondary analysis determined that patients with longer operative time, estimated blood loss, postoperative day 0/1 pain and narcotic consumption, and complications of altered mental status, postoperative anemia, fever, ileus, and urinary retention were associated with prolonged hospitalization.
Conclusion : Older patients undergoing LLIF with greater preoperative disability and more extensive fusion were more likely to require prolonged hospitalization. Male patients with higher preoperative physical function and who were diagnosed with foraminal stenosis were less likely to require prolonged hospitalization.
