Multivariable Analysis of Factors Affecting Length of Stay and Hospital Charges After Atlantoaxial Fusion

Guan, Jian; Karsy, Michael; Schmidt, Meic H.; Dailey, Andrew T.; Bisson, Erica F.

doi:10.7759/cureus.1173

Cited by 3 publications

(3 citation statements)

References 31 publications

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“…Our results suggest that a more stringent overlapping surgery policy did not lead to cost savings in our cohort, and overlapping surgery was not associated with higher or lower costs in and of itself. The variables that did appear to lead to higher hospitalization costs were largely unsurprising-complications, 5,12 emergency surgery, 11 operating room time, 15 surgery type, 6 inability to discharge home, 17 higher ASA class, 19 and tobacco use 10,16 -and have all previously been shown to be significantly associated with hospital costs. Our finding that preoperative steroid use was associated with lower costs was somewhat surprising, although some evidence suggests that such use may reduce length of stay in patients undergoing crani- otomy for tumor, which may partially explain this association.…”

Section: Discussionmentioning

confidence: 99%

Analysis of an overlapping surgery policy change on costs in a high-volume neurosurgical department

Guan¹,

Karsy²,

Brock³

et al. 2019

Journal of Neurosurgery

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OBJECTIVEOverlapping surgery remains a controversial topic in the medical community. Although numerous studies have examined the safety profile of overlapping operations, there are few data on its financial impact. The authors assessed direct hospital costs associated with neurosurgical operations during periods before and after a more stringent overlapping surgery policy was implemented.METHODSThe authors retrospectively reviewed the records of nonemergency neurosurgical operations that took place during the periods from June 1, 2014, to October 31, 2014 (pre–policy change), and from June 1, 2016, to October 31, 2016 (post–policy change), by any of the 4 senior neurosurgeons authorized to perform overlapping cases during both periods. Cost data as well as demographic, surgical, and hospitalization-related variables were obtained from an institutional tool, the Value-Driven Outcomes database.RESULTSA total of 625 hospitalizations met inclusion criteria for cost analysis; of these, 362 occurred prior to the policy change and 263 occurred after the change. All costs were reported as a proportion of the average total hospitalization cost for the entire cohort. There was no significant difference in mean total hospital costs between the prechange and postchange period (0.994 ± 1.237 vs 1.009 ± 0.994, p = 0.873). On multivariate linear regression analysis, neither the policy change (p = 0.582) nor the use of overlapping surgery (p = 0.273) was significantly associated with higher total hospital costs.CONCLUSIONSA more restrictive overlapping surgery policy was not associated with a reduction in the direct costs of hospitalization for neurosurgical procedures.

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Section: Discussionmentioning

confidence: 99%

Analysis of an overlapping surgery policy change on costs in a high-volume neurosurgical department

Guan¹,

Karsy²,

Brock³

et al. 2019

Journal of Neurosurgery

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“…4 Guan et al similarly found that between 2010 and 2015, 41% of AA fusions at a single institution were performed secondary to fracture. 7 Patients admitted due to trauma have been found to incur higher hospital charges during their stay, likely due to inherently higher costs associated with emergency care. 8,10 This may account for the rise in hospital costs and charges seen in tandem with an increase in AA fusion rates and an increase in those procedures indicated for trauma.…”

Section: Discussionmentioning

confidence: 99%

Change in rates of primary atlantoaxial spinal fusion surgeries in the United States (1993–2015)

Hendow¹,

Beschloss²,

Cazzulino³

et al. 2020

Journal of Neurosurgery: Spine

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OBJECTIVEThe objective of this study was to investigate revision burden and associated demographic and economic data for atlantoaxial (AA) fusion procedures in the US.METHODSPatient data from the National Inpatient Sample (NIS) database for primary AA fusion were obtained from 1993 to 2015, and for revision AA fusion from 2006 to 2014 using ICD-9 procedure codes. Data from 2006 to 2014 were used in comparisons between primary and revision surgeries. National procedure rates, hospital costs/charges, length of stay (LOS), routine discharge, and mortality rates were investigated.RESULTSBetween 1993 and 2014, 52,011 patients underwent primary AA fusion. Over this period, there was a 111% increase in annual number of primary surgeries performed. An estimated 1372 patients underwent revision AA fusion between 2006 and 2014, and over this time period there was a 6% decrease in the number of revisions performed annually. The 65–84 year-old age group increased as a proportion of primary AA fusions in the US from 35.9% of all AA fusions in 1997 to 44.2% in 2015, an increase of 23%. The mean hospital cost for primary AA surgery increased 32% between 2006 and 2015, while the mean cost for revision AA surgery increased by 35% between 2006 and 2014. Between 2006 and 2014, the mean hospital charge for primary AA surgery increased by 67%; the mean charge for revision surgery over that same period increased by 57%. Between 2006 and 2014, the mean age for primary AA fusions was 60 years, while the mean age for revision AA fusions was 52 years. The mean LOS for both procedures decreased over the study period, with primary AA fusion decreasing by 31% and revision AA fusion decreasing by 24%. Revision burden decreased by 21% between 2006 and 2014 (mean 4.9%, range 3.2%–6.4%). The inpatient mortality rate for primary AA surgery decreased from 5.3% in 1993 to 2.2% in 2014.CONCLUSIONSThe number of primary AA fusions between 2006 and 2014 increased 22%, while the number of revision procedures has decreased 6% over the same period. The revision burden decreased by 21%. The inpatient mortality rate decreased 62% (1993–2014) to 2.2%. The increased primary fusion rate, decreased revision burden, and decreased inpatient mortality determined in this study may suggest an improvement in the safety and success of primary AA fusion.

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“…Comorbid conditions, such as anemia, anxiety diagnosis, high body mass index, diabetes mellitus (DM), illness severity, intraoperative complications after surgery, and multilevel fusion procedures can also impact LOS. 7,8 Many studies have analyzed LOS in ALIF patients as the dependent variable in conjunction with PROMs. However, no studies have used LOS as a comparison variable.…”

Section: Introductionmentioning

confidence: 99%

Impact of Postoperative Length of Stay on Patient-Reported and Clinical Outcomes After Anterior Lumbar Interbody Fusion

et al. 2022

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Background: Existing literature has not yet evaluated the impact of postoperative length of stay (LOS) on patientreported outcome measures (PROMs) and minimum clinically important difference (MCID) in patients undergoing anterior lumbar interbody fusion (ALIF). The authors investigates the influence of postoperative LOS following ALIF on PROMs and MCID achievement rates.Methods: A single-surgeon database was retrospectively reviewed for patients undergoing single-level ALIF. The following 2 cohorts were studied: patients with LOS <45 hours and patients with LOS ≥45 hours. The following PROMs were recorded at preoperative and 6-week, 12-week, 6-month, 1-year, and 2-year postoperative timepoints: visual analog scale (VAS) back and leg, Oswestry Disability Index (ODI), 12-item short form (SF-12) physical composite score (PCS), and patientreported outcome measurement information system physical function. MCID achievement was compared by LOS grouping using χ 2 analysis. The rates of complications by LOS grouping and the relative risk among demographic and perioperative characteristics for a longer hospital stay of ≥45 hours were calculated.Results: A total of 52 subjects were included in each cohort. LOS ≥45 hours demonstrated worse ODI at 6 weeks and SF-12 PCS preoperative and at 12 weeks (P ≤ 0.026, all). LOS <45 hours demonstrated greater MCID rates for all PROMs except VAS back (P ≤ 0.004, all). Postoperative urinary retention (POUR), fever, and total complications (P ≤ 0.003, all) were associated with increased LOS. Diabetes (P = 0.037), preoperative VAS neck ≥7 (P = 0.012), and American Society of Anesthesiologists classification ≥2 (P = 0.003) served as preoperative risk factors for postoperative stay ≥45 hours.Conclusion: Following single-level ALIF, patients with shorter LOS demonstrated significantly greater overall MCID achievement for most PROMs. POUR, fever, and total complications were associated with longer LOS and greater blood loss. Diabetes and higher preoperative leg pain were identified as risk factors for longer LOS.Clinical Relevance: Patients undergoing ALIF with shorter LOS had greater MCID achievement for disability, physical function, and leg pain outcomes. Patients with greater preoperative leg pain and diabetes may be at risk for longer LOS.

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Multivariable Analysis of Factors Affecting Length of Stay and Hospital Charges After Atlantoaxial Fusion

Cited by 3 publications

References 31 publications

Analysis of an overlapping surgery policy change on costs in a high-volume neurosurgical department

Analysis of an overlapping surgery policy change on costs in a high-volume neurosurgical department

Change in rates of primary atlantoaxial spinal fusion surgeries in the United States (1993–2015)

Impact of Postoperative Length of Stay on Patient-Reported and Clinical Outcomes After Anterior Lumbar Interbody Fusion

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