Preoperative predictors of prolonged hospitalization in patients undergoing lateral lumbar interbody fusion

• Published in: Acta neurochirurgica Vol. 165; no. 9; pp. 2615 - 2624
• Main Authors: Nie, James W., Hartman, Timothy J., MacGregor, Keith R., Oyetayo, Omolabake O., Zheng, Eileen, Federico, Vincent P., Massel, Dustin H., Sayari, Arash J., Singh, Kern
• Format: Journal Article
• Language: English
• Published: Vienna Springer Vienna 01-09-2023; Springer Nature B.V
• Subjects: Blood transfusion; Comorbidity; Gender; Hospitalization; Interventional Radiology; Length of stay; Medicine; Medicine & Public Health; Minimally Invasive Surgery; Neurology; Neuroradiology; Neurosurgery; Original Article; Patients; Regression analysis; Spine - Other; Spondylolisthesis; Stenosis; Surgical Orthopedics; LOS; LLIF; Predictors
• ISSN: 0942-0940; 0001-6268; 0942-0940
• DOI: 10.1007/s00701-023-05648-w

Purpose
We aim to examine the preoperative factors associated with increased postoperative length of stay in patients undergoing LLIF in the hospital setting.
Methods
Patient demographics, perioperative characteristics, and patient-reported outcome measures (PROMs) were collected from a single-surgeon database. Patients undergoing LLIF in the hospital setting were separated into postoperative LOS <48 h (H) and LOS ≥ 48H. Univariate analysis for preoperative characteristics was utilized to determine covariates for multivariable logistic regression. Multivariable logistic regression was then utilized to determine significant predictors of extended postoperative length of stay. Secondary univariate analysis of inpatient complications, operative, and postoperative characteristics were calculated to determine postoperative factors associated with prolonged hospitalization.
Results
Two-hundred and forty patients were identified with 115 patients’ LOS ≥ 48H. Univariate analysis identified age/Charlson Comorbidity Index (CCI) score/gender/insurance type/number of contiguous fused levels/preoperative PROMs of Visual Analog Scale (VAS) back/VAS leg/Patient-Reported Outcomes Measurement Information System (PROMIS-PF)/Oswestry Disability Index (ODI)/degenerative spondylolisthesis diagnoses/foraminal stenosis/central stenosis for multivariable logistic regression. Multivariable logistic regression calculated significant positive predictors of LOS ≥ 48H to be age/3-level fusion/preoperative ODI scores. Negative predictors of LOS ≥ 48H were the diagnosis of foraminal stenosis/preoperative PROMIS-PF/male gender. The secondary analysis determined that patients with longer operative time/estimated blood loss/transfusion/postoperative day 0 and 1 pain and narcotic consumption/complications of altered mental status/postoperative anemia/fever/ileus/urinary retention were associated with prolonged hospitalization.
Conclusion
Older patients undergoing LLIF with greater preoperative disability and 3-level fusion were more likely to require prolonged hospitalization. Male patients with higher preoperative physical function and who were diagnosed with foraminal stenosis were less likely to require prolonged hospitalization.