Preoperative factors affecting length of stay after elective anterior cervical discectomy and fusion with and without corpectomy: a multivariate analysis of an academic center cohort

Abstract

Study design: Retrospective cohort study of 183 patients who underwent elective anterior cervical discectomy and fusion (ACDF) at a single institution during a 2-year period.

Objective: To determine which preoperative factors were independently associated with a prolonged hospital length of stay (LOS) after ACDF.

Summary of background data: ACDF has become the most common treatment modality for addressing cervical spine pathology. Extended LOS after ACDF is associated with increased costs and complications. There is a lack of conclusive data for factors affecting LOS after ACDF. This study aims to create a multivariate model to determine the association of various patient and operative characteristics with LOS after ACDF.

Methods: Patients who underwent elective ACDF at a single academic institution between January 2011 and February 2013 were identified using billing records. Their charts were reviewed to collect variables available preoperatively such as patient demographics, comorbidities, and surgery planned. Patients were categorized as normal or extended LOS, with extended LOS defined as LOS more than the 75th percentile. A multivariate logistic regression was used to determine which factors were independently associated with extended LOS.

Results: A total of 183 patients with ACDF were identified. The average LOS for this cohort was 2.0 ± 2.5 days (mean ± standard deviation). Extended LOS was defined as 3 days or more. Multivariate analysis revealed that preoperative factors independently associated with extended LOS were history of nonspinal malignancy (odds ratio [OR] = 4.9), history of pulmonary disease (OR = 4.0), and procedures that included corpectomy (OR = 4.5).

Conclusion: Patients with a history of nonspinal malignancy or pulmonary disease, as well as patients who underwent corpectomy, were more likely to have an extended LOS (ORs, 4.0-4.9). Of significant note, other factors that one might expect to be associated with extended LOS did not independently predict extended LOS in this analysis.

Level of evidence: 3.

Figure 1

Length of stay (LOS) after anterior cervical discectomy and fusion (ACDF). Extended LOS was defined as one greater than the 75^th percentile LOS, which was 2 days. LOS of 3 days or greater was thus considered extended LOS. Patients discharged to the right of the vertical dashed line had an extended LOS.