Shin JI, et al. - Researchers used a large national database to identify patient factors that were independently correlated with prolonged length of stay (LOS) and readmission after posterior cervical fusion (PCF). Multivariate analysis revealed that factors significantly associated with increased LOS were dependent functional status, diabetes mellitus, preoperative anemia, American Society of Anesthesiologists class 3 or 4, and the number of fused levels. These factors would be useful in enhanced informed consent before surgery, surgical planning, discharge planning, and optimizing postoperative care.

Methods

• Between 2011 to 2014, the researchers queried the American College of Surgeons National Surgical Quality Improvement Program database.
• They used current Procedural Terminology code 22600 to identify patients who underwent PCF.
• Using bivariate and multivariate logistic regressions, all patient factors were assessed for association with LOS and readmission rate.

Results

• The inclusion criteria for LOS analysis was met by 2,667 patients who underwent PCF.
• In this study, average (±SD) LOS was 3.92 (±3.24) days, and median LOS was 3 days (interquartile range, 2-5 d).
• In multivariate analysis, dependent functional status (P < 0.001), diabetes mellitus (P=0.021), preoperative anemia (P=0.001), American Society of Anesthesiologists class 3 or 4 (P < 0.001), and number of fused levels (P < 0.001) were significantly associated with increased LOS.
• For analysis of readmission, 2,591 patients met criteria (LOS≤11 d).
• Among these patients, readmission rate was 7.1%.
• Among patients who were not readmitted within 30 days of operation, the average (±SD) LOS was 3.89 (±3.25), while the average (±SD) LOS of the patients readmitted was 4.24 (±3.08).
• The multivariate analysis revealed that readmission was significantly correlated with only dependent functional status (P=0.019) and increased number of fused levels (P=0.032).