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Factors affecting hospital length of stay following anterior cervical discectomy and fusion.

ABSTRACT: STUDY DESIGN: Retrospective cohort study. BACKGROUND: Several studies focus on the long-term results of anterior cervical discectomy and fusion (ACDF) surgeries, but little information exists regarding how various patient-related, procedure-related, and payer-related variables may affect postoperative hospital length of stay (LOS). OBJECTIVE: To determine what factors, if any, contribute to increased hospital LOS in patients who have had an ACDF. METHODS: Retrospective cohort study of 108 consecutive patients who underwent elective ACDF at a Midwest academic medical center. Extensive preoperative, intraoperative, and postoperative data were abstracted and analyzed to identify prognostic factors for an increased LOS. Multivariate analysis was performed to analyze the effects of patient and hospital characteristics on hospital LOS. RESULTS: 103 patients met inclusion and exclusion criteria. The mean LOS for patients undergoing ACDF was 1.98 (±1.6) days. Only 29% of patients had one level fused. The mean blood loss during surgery was 87.4 ± 99.6 mL. One subject lost 700 mL of blood. Complications, though rare, included uncontrolled postoperative pain (13%), cardiac (6%), pulmonary (4%), and urinary (3%). Covariates included in the final model were age, sex, cardiac complication, urinary complication, and pulmonary complication. Factors that contributed to increased LOS and their associated adjusted mean days were: ≥50 years of age (2.5 ± 1.2 days), female gender (2.3 ± 1.2 days), and three particular types of complications. The complications that had the largest effect on increased LOS from least to most severe were cardiac (3.5 ± 1.3 days), urinary (4.7 ± 1.3 days), and pulmonary (5.3 ± 1.3 days). CONCLUSIONS: The information presented in this study may be useful for patients, clinicians, and insurance companies, including precertification and case-management services. Our results can be instrumental in designing future prospective studies using more detailed analyses with more patients, more surgeons, and multiple institutions. [Table: see text].

SUBMITTER: Arnold PM

PROVIDER: S-EPMC3604758 | biostudies-other | 2011 Aug

REPOSITORIES: biostudies-other

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Project description:IntroductionAnterior cervical discectomy and fusion (ACDF) is a commonly performed procedure for the treatment of degenerative cervical disease. With continued increase in U.S. healthcare expenditure, surgeons have begun to more closely examine the benefits of performing ACDF in an outpatient setting to increase efficiency, reduce the overall financial burden on patients/providers, and provide streamlined care for these patients. The purpose of this study was to analyze outcomes following outpatient ACDF for the treatment of myelopathy.Methods14,490 patients who had undergone ACDF for myelopathy from 2010 to 2018 were included in this retrospective study, of which 2956 (20.40%) patients were considered to have undergone outpatient surgery. Pearson chi-squared tests and Fischer's Exact Tests were used to analyze differences in categorical variables of demographics, preoperative comorbidities, and postoperative complications, while Mann-Whitney-U-Tests were used to compare mean values of continuous variables. Coarsened-exact-matching (CEM) was implemented to control for baseline differences in demographics and comorbidities, and post-matching diagnostics included multivariate and univariate imbalance measure assessment. Outcomes were compared between the CEM-matched inpatient and outpatients ACDF cohorts.ResultsUpon CEM-matching (L1-statistic <0.001), the outpatient cohort (n = 2610, 25.13%) demonstrated significantly lower rates of any complication (p < 0.001), minor complications (p = 0.001), urinary tract infections (p = 0.029), blood transfusions (p < 0.001), major complications (p < 0.001), deep incisional surgical site infections (p = 0.017), ventilator dependence (p = 0.027), cardiac arrest (p = 0.028), unplanned reoperations (p = 0.001), and mortality (p = 0.006) in the 30-day postoperative period when compared to inpatient controls (n = 7774, 74.87%).ConclusionACDF has been a target amongst spinal procedures as a prime candidate for outpatient surgery. However, no previous reports have described complication rates and perioperative parameters in the sub-population of outpatient ACDF patients with myelopathy. In addition to shorter times from admission to operating room, operative time, and LOS, our study also demonstrated lower rates of major and overall complications in outpatient ACDF's for myelopathy in comparison to their inpatient counterparts. Performing ACDF's for myelopathy in an outpatient setting may help to curb costs, improve outcomes, and serve as a valuable learning resource for graduate medical education with rapid turnovers and shorter operative times.

Project description:BackgroundBrachioradial pruritus (BRP) is a rare, chronic condition that typically presents in middle-aged light-skinned females as itching of the dorsolateral upper extremities in the C5-C6 dermatome distribution. Cervical nerve compression and ultraviolet (UV) radiation are largely considered to be causative factors. There have been very few case reports where surgical decompression was used to treat BRP. This case report is unique because our patient had a brief period of symptom recurrence 2 months post-operation as supported by displacement of the cage on imaging. The patient then underwent implant removal and revision with the use of an anterior plate leading to complete symptom resolution.Case descriptionA 72-year-old female presenting with a 2-year history of severe, persistent pruritus and mild pain of bilateral arms and forearms. The patient was being followed by her dermatologic providers for 10+ years for other unrelated diagnoses. She was referred to our office after having trialed multiple topical medications, oral medications, and injections without lasting definitive success. Cervical spine radiographs demonstrated severe degenerative disc disease with osteophyte formation at C5-C6. Cervical magnetic resonance imaging (MRI) revealed disc herniation at C5-C6 causing mild cord compression with bilateral foraminal stenosis. Patient proceeded with anterior cervical discectomy and fusion at C5-C6, which provided immediate symptom relief. Two months post-operation, her symptoms recurred and repeat cervical spine radiographs revealed cage migration. The patient underwent a revision of fusion by removal of the cage and placement of an anterior plate. At her most recent 2-year follow-up visit, she has been doing well post-operatively without any pain or pruritus.ConclusionsThis case report illustrates the use of surgical intervention as a viable treatment option for specific patients with persistent BRP that have failed all other forms of conservative management. Cervical radiculopathy should be included in the differential diagnosis until ruled out by advanced imaging, particularly in cases of BRP that are refractory to standard dermatological treatment.

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:IntroductionTo analyze the perioperative hidden blood loss (HBL) and its influencing factors in elderly cervical spondylosis patients treated with anterior cervical discectomy fusion (ACDF).Materials and methodsFrom January 2017 to December 2018, 128 elderly cervical spondylosis patients (age > 65 y) treated with ACDF were selected. The patients' height, weight, duration of symptoms, previous medical history and other basic information were routinely recorded. The hemoglobin (Hb), hematocrit (Hct) and blood coagulation function preoperative and the next day postoperative were recorded. The operation time, surgical bleeding, ASA classification, fixation method, total drainage and the time for extraction of drainage tube were recorded. The total blood loss (TBL) was calculated according to the Gross's formula, and HBL was calculated based on TBL, total drainage and surgical bleeding. The statistical analysis of HBL was performed, and then influential factors were further analyzed by multivariate linear regression analysis and t test.ResultsThe mean surgical bleeding was 102.70 ± 46.78 mL and HBL was 487.98 ± 255.96 mL. HBL accounted for 67.61 ± 5.20% of TBL. According to the multiple linear regression analysis, the gender (P = 0.047), operation time (P = 0.000), fixation method (P = 0.014) and international normalized ratio (INR) (P = 0.003) influenced the amount of HBL. Body mass index (BMI) (P = 0.624), hypertension (P = 0.977), diabetes (P = 0.528), blood type (P = 0.577), ASA classification (P = 0.711), duration of symptoms (P = 0.661), preoperative cobb angle (P = 0.152), number of surgical level (P = 0.709), intramedullary hyperintensity (P = 0.967), drainage time (P = 0.294), postoperative drainage volume (P = 0.599), prothrombin time (PT) (P = 0.674), activated partial thromboplastin time (APTT) (P = 0.544) and thrombin time (TT) (P = 0.680) had no correlation with the amount of HBL.ConclusionsThere was obvious HBL during the perioperative period of ACDF in elderly cervical spondylosis patients. The male patients, longer operation time, fusion with titanium plate and cage and high INR were independent risk factors for HBL.

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Factors affecting hospital length of stay following anterior cervical discectomy and fusion.

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