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Patient characteristics associated with increased postoperative length of stay and readmission after elective laminectomy for lumbar spinal stenosis.

ABSTRACT: Retrospective cohort.To identify factors that were independently associated with increased postoperative length of stay (LOS) and readmission in patients who underwent elective laminectomy for lumbar spinal stenosis.Lumbar spinal stenosis is a common pathology that is traditionally treated with decompressive laminectomy. Risk factors associated with increased LOS and readmission have not been fully characterized for laminectomy.Patients who underwent laminectomy for lumbar spinal stenosis during 2011 and 2012 were identified from the American College of Surgeons National Surgical Quality Improvement Program database. Patient characteristics were tested for association with LOS and readmission using bivariate and multivariate analyses. Patients with LOS more than 10 days were excluded from the readmission analysis as the American College of Surgeons National Surgical Quality Improvement Program only captures readmissions within 30 postoperative days, and the window for potential readmission was deemed too short for patients staying longer than 10 days.A total of 2358 patients who underwent laminectomy met inclusion criteria. The average age was 66.4 ± 11.7 years (mean ± standard deviation). Average postoperative LOS was 2.1 ± 2.6 days. Of those meeting criteria for readmission analysis, 3.7% of patients (86 of 2339) were readmitted within 30 days postoperatively.Independent risk factors for prolonged LOS were increased age (P < 0.001), increased body mass index (P = 0.004), American Society of Anesthesiologists class 3-4 (P = 0.005), and preoperative hematocrit less than 36.0 (P = 0.001). Independent risk factors for readmission were increased age (P = 0.013), increased body mass index (P = 0.040), American Society of Anesthesiologists class 3-4 (P < 0.001), and steroid use (P = 0.001). The most common reason for readmission was surgical site-related infections (25.0% of patients readmitted in 2012).The identified factors associated with LOS and readmission after lumbar laminectomy may be useful for optimizing patient care.

SUBMITTER: Basques BA

PROVIDER: S-EPMC4006290 | biostudies-literature | 2014 May

REPOSITORIES: biostudies-literature

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Patient characteristics associated with increased postoperative length of stay and readmission after elective laminectomy for lumbar spinal stenosis.

Basques Bryce A BA Varthi Arya G AG Golinvaux Nicholas S NS Bohl Daniel D DD Grauer Jonathan N JN

Spine 20140501 10

<h4>Study design</h4>Retrospective cohort.<h4>Objective</h4>To identify factors that were independently associated with increased postoperative length of stay (LOS) and readmission in patients who underwent elective laminectomy for lumbar spinal stenosis.<h4>Summary of background data</h4>Lumbar spinal stenosis is a common pathology that is traditionally treated with decompressive laminectomy. Risk factors associated with increased LOS and readmission have not been fully characterized for lamine ...[more]

PMID: 24525996

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Project description:Study designSecondary analysis of a randomized controlled trial.ObjectiveTo identify preoperative physical variables associated with favorable postoperative outcome in individuals undergoing laminectomy or laminotomy for degenerative central lumbar spinal stenosis.Summary of background dataClinical or condition specific variables have most commonly been studied as predictors of postoperative outcome in lumbar spinal stenosis. If associated to favorable postoperative outcome, modifiable physical variables would inform prehabilitation interventions for patients with degenerative central lumbar spinal stenosis.MethodsPatients awaiting surgery for central lumbar spinal stenosis were recruited to participate in a randomized controlled trial. Following baseline data collection of demographics, clinical portrait and physical testing, participants were randomized to either 6-week active prehabilitation program or hospital standard care. Complete baseline and postoperative data were obtained from 58 participants which were included in the present analysis. Favorable postoperative outcome was determined based on two outcome measures. Favorable outcome was defined as a decrease of ≥30% on the Numerical Rating Scale for leg pain intensity and a decrease of ≥30% on the Oswestry Disability Index for low back disability. Baseline physical variables were used to conduct binary logistic regression.ResultsSixty percent of participants were determined as having a favorable postoperative outcome. None of the included physical variables were found to be predictors of a favorable postoperative outcome based on leg pain intensity and low back pain-associated disability [trunk flexors muscle strength (OR = 0.73; 95%CI (0.02-27.12)] lumbar extensors muscle endurance [OR= 1.09; 95%CI (0.95-1.24)] total ambulation time [OR = 1.00 95%CI (0.99-1.01)] lumbar active range of motion in extension [OR = 1.08; 95%CI (0.95-1.23)] and knee extensors muscle strength [OR=1.02; 95%CI (0.98-1.06)].ConclusionResults show that none of the investigated variables, all related to low back and lower limbs physical capacity, were predictors of postoperative recovery. Further testing in larger cohort is needed to assess the full potential of physical outcome measures as predictors of postoperative recovery.

Project description:BackgroundIn 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.MethodsWe 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.Results779 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.ConclusionsPatient 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.

Project description:Study designRetrospective cohort study of the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2010 that included 1861 patients who had undergone elective posterior lumbar fusion.ObjectiveTo characterize factors that were independently associated with increased hospital length of stay (LOS) in patients who had undergone elective posterior lumbar fusion.Summary of background dataPosterior lumbar spine fusion is a common surgical procedure used to treat lumbar spine pathology. LOS is an important clinical variable and a major determinant of inpatient hospital costs. There is lack of studies in the literature using multivariate analysis to examine specifically the predictors of LOS after elective posterior lumbar fusion.MethodsPatients who underwent elective posterior lumbar fusion from 2005 to 2010 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Preoperative and intraoperative variables were extracted for each case and a multivariate linear regression was performed to assess the contribution of each variable to LOS.ResultsA total of 1861 patients who had undergone elective posterior lumbar fusion were identified. The average age for patients in this cohort was 60.6 ± 13.9 years (mean ± standard deviation) with a body mass index of 30.3 ± 6.2 kg/m. Of the total patients, 44.7% of patients were male. LOS was in the range from 0 days to 51 days. Multivariate linear regression identified age (P < 0.001), morbid obesity (body mass index ≥ 40 kg/m, P < 0.001), American Society of Anesthesiologists class (P = 0.001), operative time (P < 0.001), multilevel procedure (P = 0.001), and intraoperative transfusion (P < 0.001) as significant predictors of extended LOS.ConclusionThe identified preoperative and intraoperative variables associated with extended LOS after elective posterior lumbar fusion may be helpful to clinicians for patient counseling and postoperative planning.Level of evidence3.

Project description:Purpose:To develop a self-administered diagnostic screening questionnaire for lumbar spinal stenosis (LSS) consisting of items with high content validity and to investigate the diagnostic value of the questionnaire and the items. Patients and Methods:A self-reported diagnostic LSS screening questionnaire was developed based on items from the existing literature describing key symptoms of LSS. The screening questionnaire (index test) was to be tested in a cohort of patients with persistent lumbar and/or leg pain recruited from a Danish publicly funded outpatient secondary care spine clinic with clinicians performing the reference test. However, to avoid unnecessary collection of data if the screening questionnaire proved to be of limited value, a case-control design was incorporated into the cohort design including an interim analysis. Additional cases for the case-control study were recruited at two Danish publicly funded spine surgery departments. Prevalence, sensitivity, specificity and diagnostic odds ratio (OR) were calculated for each individual item, and AUC (area under the curve) was calculated to examine the performance of the full questionnaire. Results:A 13-item Danish questionnaire was developed and tested in 153 cases and 230 controls. The interim analysis was not in favour of continuing the cohort study, and therefore, only results from the case-control study are reported. There was a positive association for all items except the presence of back pain. However, the association was only moderate with ORs up to 3.3. When testing the performance of the whole questionnaire, an AUC of 0.72 was reached with a specificity of 20% for a fixed sensitivity of 95%. Conclusion:The items were associated with LSS and therefore have some potential to identify LSS patients. However, the association was not strong enough to provide sufficient accuracy for a diagnostic tool. Additional dimensions of symptoms of LSS need identification to obtain a reliable questionnaire for screening purposes.

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Patient characteristics associated with increased postoperative length of stay and readmission after elective laminectomy for lumbar spinal stenosis.

Publications

Patient characteristics associated with increased postoperative length of stay and readmission after elective laminectomy for lumbar spinal stenosis.

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