Neighborhood-level socioeconomic status, extended length of stay, and discharge disposition following elective lumbar spine surgery
Background: In the context of increased attention afforded to hospital efficiency and improved but safe patient throughput, decreasing unnecessary hospital length of stay (LOS) is imperative. Given that lumbar spine procedures may be among a hospital's most profitable services, identifying pati...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2022-12-01
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| Series: | North American Spine Society Journal |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666548422000907 |
| _version_ | 1811292651977179136 |
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| author | Matthew J. Hagan Rahul A. Sastry Joshua Feler Hael Abdulrazeq Patricia Z. Sullivan Jose Fernandez Abinader Joaquin Q. Camara Tianyi Niu Jared S. Fridley Adetokunbo A. Oyelese Prakash Sampath Albert E. Telfeian Ziya L. Gokaslan Steven A. Toms Robert J. Weil |
| author_facet | Matthew J. Hagan Rahul A. Sastry Joshua Feler Hael Abdulrazeq Patricia Z. Sullivan Jose Fernandez Abinader Joaquin Q. Camara Tianyi Niu Jared S. Fridley Adetokunbo A. Oyelese Prakash Sampath Albert E. Telfeian Ziya L. Gokaslan Steven A. Toms Robert J. Weil |
| author_sort | Matthew J. Hagan |
| collection | DOAJ |
| description | Background: In the context of increased attention afforded to hospital efficiency and improved but safe patient throughput, decreasing unnecessary hospital length of stay (LOS) is imperative. Given that lumbar spine procedures may be among a hospital's most profitable services, identifying patients at risk of increased healthcare resource utilization prior to surgery is a valuable opportunity to develop targeted pre- and peri-operative intervention and quality improvement initiatives. The purpose of the present investigation was to examine patient factors that predict prolonged LOS as well as discharge disposition following elective, posterior, lumbar spine surgery. Methods: We employed a retrospective cohort analysis on 779 consecutive patients treated with lumbar surgery without fusion. Our primary outcome measures were extended LOS (three or more midnights) and discharge disposition. Patient sociodemographic, procedural, and discharge characteristics were adjusted for in our analysis. Sociodemographic variables included Area of Deprivation Index (ADI), a comprehensive metric of socioeconomic status, utilizing income, education, employment, and housing quality based on patient zip code. Multivariable logistic regression and ordinal logistic regression analyses were performed to assess whether covariates were independently predictive of extended LOS and discharge disposition, respectively. Results: 779 patients were studied, with a median age of 66 years (±15) and a median LOS of 1 midnight (range, 1-10 midnights). Patients in the most disadvantaged ADI quintile (adjusted odds ratio, aOR 2.48 95% CI 1.15-5.47), those who underwent a minimally-invasive or tubular retractor surgery (aOR 3.03 95% CI 1.02-8.56), those who had an intra-operative drain placed (aOR 4.46 95% CI 2.53-7.26), who had a cerebrospinal fluid leak (aOR 3.46 95% CI 1.55-7.58), who were discharged anywhere but home (aOR 17.11 95% CI 9.24-33.00), and those who were evaluated by physical therapy (aOR 7.23 95% CI 2.13-45.30) or OT (aOR 2.20 95% CI 1.13-4.22) had a significantly increased chance of an extended LOS. Preoperative opioid use was not associated with an increased LOS following surgery (aOR 1.12 95% CI 0.56-1.46). Extended LOS was not associated with post-discharge emergency department representation or unplanned readmission within 90 days following discharge (p=0.148). Patients who were older (aOR 1.99 95% CI 1.62-2.48), in higher quintiles on ADI (3rd quintile; aOR 1.90 95% CI 1.12-3.23, 4th quintile; aOR 1.79, 95% CI 1.05-3.05, 5th quintile; aOR 2.16 95% CI 1.26-3.75), who had a CSF leak (aOR 2.18 95% CI 1.22-3.86), or who had a longer procedure duration (aOR 1.38 95% CI 1.17-1.62) were more likely to require additional services or be sent to a subacute facility upon discharge. Conclusions: Patient sociodemographics, along with procedural factors, and discharge disposition were all associated with an increased likelihood of prolonged LOS and resource intensive discharges following elective lumbar spine surgery. Several of these factors could be reliably identified pre-operatively and may be amenable to targeted preoperative intervention. Improving discharge disposition planning in the peri-operative period may allow for more efficient use of hospitalization and inpatient and post-acute resources. |
| first_indexed | 2024-04-13T04:48:32Z |
| format | Article |
| id | doaj.art-28741756a42b418698c5e50876f4420d |
| institution | Directory Open Access Journal |
| issn | 2666-5484 |
| language | English |
| last_indexed | 2024-04-13T04:48:32Z |
| publishDate | 2022-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | North American Spine Society Journal |
| spelling | doaj.art-28741756a42b418698c5e50876f4420d2022-12-22T03:01:45ZengElsevierNorth American Spine Society Journal2666-54842022-12-0112100187Neighborhood-level socioeconomic status, extended length of stay, and discharge disposition following elective lumbar spine surgeryMatthew J. Hagan0Rahul A. Sastry1Joshua Feler2Hael Abdulrazeq3Patricia Z. Sullivan4Jose Fernandez Abinader5Joaquin Q. Camara6Tianyi Niu7Jared S. Fridley8Adetokunbo A. Oyelese9Prakash Sampath10Albert E. Telfeian11Ziya L. Gokaslan12Steven A. Toms13Robert J. Weil14Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, 593 Eddy Street, APC 6, Providence, RI 02903, United StatesDepartment of Neurosurgery, Warren Alpert School of Medicine, Brown University, 593 Eddy Street, APC 6, Providence, RI 02903, United States; Corresponding author at: Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Rhode Island Hospital, 593 Eddy St, APC 6, Providence, RI 02903, United States.Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, 593 Eddy Street, APC 6, Providence, RI 02903, United StatesDepartment of Neurosurgery, Warren Alpert School of Medicine, Brown University, 593 Eddy Street, APC 6, Providence, RI 02903, United StatesDepartment of Neurosurgery, Warren Alpert School of Medicine, Brown University, 593 Eddy Street, APC 6, Providence, RI 02903, United StatesDepartment of Neurosurgery, Warren Alpert School of Medicine, Brown University, 593 Eddy Street, APC 6, Providence, RI 02903, United StatesDepartment of Neurosurgery, Warren Alpert School of Medicine, Brown University, 593 Eddy Street, APC 6, Providence, RI 02903, United StatesDepartment of Neurosurgery, Warren Alpert School of Medicine, Brown University, 593 Eddy Street, APC 6, Providence, RI 02903, United StatesDepartment of Neurosurgery, Warren Alpert School of Medicine, Brown University, 593 Eddy Street, APC 6, Providence, RI 02903, United StatesDepartment of Neurosurgery, Warren Alpert School of Medicine, Brown University, 593 Eddy Street, APC 6, Providence, RI 02903, United StatesDepartment of Neurosurgery, Warren Alpert School of Medicine, Brown University, 593 Eddy Street, APC 6, Providence, RI 02903, United StatesDepartment of Neurosurgery, Warren Alpert School of Medicine, Brown University, 593 Eddy Street, APC 6, Providence, RI 02903, United StatesDepartment of Neurosurgery, Warren Alpert School of Medicine, Brown University, 593 Eddy Street, APC 6, Providence, RI 02903, United StatesDepartment of Neurosurgery, Warren Alpert School of Medicine, Brown University, 593 Eddy Street, APC 6, Providence, RI 02903, United StatesSouthcoast Health Brain & Spine, 480 Hawthorn St, Dartmouth, MA 02747, United StatesBackground: In the context of increased attention afforded to hospital efficiency and improved but safe patient throughput, decreasing unnecessary hospital length of stay (LOS) is imperative. Given that lumbar spine procedures may be among a hospital's most profitable services, identifying patients at risk of increased healthcare resource utilization prior to surgery is a valuable opportunity to develop targeted pre- and peri-operative intervention and quality improvement initiatives. The purpose of the present investigation was to examine patient factors that predict prolonged LOS as well as discharge disposition following elective, posterior, lumbar spine surgery. Methods: We employed a retrospective cohort analysis on 779 consecutive patients treated with lumbar surgery without fusion. Our primary outcome measures were extended LOS (three or more midnights) and discharge disposition. Patient sociodemographic, procedural, and discharge characteristics were adjusted for in our analysis. Sociodemographic variables included Area of Deprivation Index (ADI), a comprehensive metric of socioeconomic status, utilizing income, education, employment, and housing quality based on patient zip code. Multivariable logistic regression and ordinal logistic regression analyses were performed to assess whether covariates were independently predictive of extended LOS and discharge disposition, respectively. Results: 779 patients were studied, with a median age of 66 years (±15) and a median LOS of 1 midnight (range, 1-10 midnights). Patients in the most disadvantaged ADI quintile (adjusted odds ratio, aOR 2.48 95% CI 1.15-5.47), those who underwent a minimally-invasive or tubular retractor surgery (aOR 3.03 95% CI 1.02-8.56), those who had an intra-operative drain placed (aOR 4.46 95% CI 2.53-7.26), who had a cerebrospinal fluid leak (aOR 3.46 95% CI 1.55-7.58), who were discharged anywhere but home (aOR 17.11 95% CI 9.24-33.00), and those who were evaluated by physical therapy (aOR 7.23 95% CI 2.13-45.30) or OT (aOR 2.20 95% CI 1.13-4.22) had a significantly increased chance of an extended LOS. Preoperative opioid use was not associated with an increased LOS following surgery (aOR 1.12 95% CI 0.56-1.46). Extended LOS was not associated with post-discharge emergency department representation or unplanned readmission within 90 days following discharge (p=0.148). Patients who were older (aOR 1.99 95% CI 1.62-2.48), in higher quintiles on ADI (3rd quintile; aOR 1.90 95% CI 1.12-3.23, 4th quintile; aOR 1.79, 95% CI 1.05-3.05, 5th quintile; aOR 2.16 95% CI 1.26-3.75), who had a CSF leak (aOR 2.18 95% CI 1.22-3.86), or who had a longer procedure duration (aOR 1.38 95% CI 1.17-1.62) were more likely to require additional services or be sent to a subacute facility upon discharge. Conclusions: Patient sociodemographics, along with procedural factors, and discharge disposition were all associated with an increased likelihood of prolonged LOS and resource intensive discharges following elective lumbar spine surgery. Several of these factors could be reliably identified pre-operatively and may be amenable to targeted preoperative intervention. Improving discharge disposition planning in the peri-operative period may allow for more efficient use of hospitalization and inpatient and post-acute resources.http://www.sciencedirect.com/science/article/pii/S2666548422000907EpidemiologyLumbar degenerative non-deformity |
| spellingShingle | Matthew J. Hagan Rahul A. Sastry Joshua Feler Hael Abdulrazeq Patricia Z. Sullivan Jose Fernandez Abinader Joaquin Q. Camara Tianyi Niu Jared S. Fridley Adetokunbo A. Oyelese Prakash Sampath Albert E. Telfeian Ziya L. Gokaslan Steven A. Toms Robert J. Weil Neighborhood-level socioeconomic status, extended length of stay, and discharge disposition following elective lumbar spine surgery North American Spine Society Journal Epidemiology Lumbar degenerative non-deformity |
| title | Neighborhood-level socioeconomic status, extended length of stay, and discharge disposition following elective lumbar spine surgery |
| title_full | Neighborhood-level socioeconomic status, extended length of stay, and discharge disposition following elective lumbar spine surgery |
| title_fullStr | Neighborhood-level socioeconomic status, extended length of stay, and discharge disposition following elective lumbar spine surgery |
| title_full_unstemmed | Neighborhood-level socioeconomic status, extended length of stay, and discharge disposition following elective lumbar spine surgery |
| title_short | Neighborhood-level socioeconomic status, extended length of stay, and discharge disposition following elective lumbar spine surgery |
| title_sort | neighborhood level socioeconomic status extended length of stay and discharge disposition following elective lumbar spine surgery |
| topic | Epidemiology Lumbar degenerative non-deformity |
| url | http://www.sciencedirect.com/science/article/pii/S2666548422000907 |
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