Longer stay, greater costs related to late-week laminectomy
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New research by a team has determined that surgeries performed late in the workweek, and those culminating in discharge to a specialty care facility, are associated with higher costs and unnecessarily long stays in the hospital following common elective spine surgery.

The authors' goal in this study was to distinguish between clinical and non-clinical factors that drive the length of a patient's stay in the hospital for this common spine procedure and to understand the relationships between these factors and both patient outcomes and hospital costs.

Researchers retrospectively reviewed the data for all adult patients who underwent elective lumbar laminectomy over a nearly three-year period. Generalized linear modeling was used to assess the relationships between the day of surgery, patient discharge disposition, and length of hospital stay (LOS), while adjusting for underlying patient health risks and other nonclinical factors, including the hospital surgery site and health insurance.

A total of 1359 eligible patients were included.

-- The mean LOS ranged between 2.01 and 2.47 days for Monday and Friday cases, respectively.

--The LOS was also notably longer for patients who were ultimately discharged to a skilled nursing facility (SNF) or rehabilitation center.

--A prolonged LOS occurring later in the week was not associated with greater underlying health risks, yet it nevertheless resulted in greater costs of care: the average total surgical costs for lumbar laminectomy were 20% greater for Friday cases than for Monday cases, and 24% greater for late-week cases than for early-week cases ultimately transferred to SNFs or rehabilitation centers.

Conclusively, late-week surgeries are associated with prolonged LOS, particularly when discharge is to an SNF or rehabilitation center. Interventions to optimize surgical scheduling and perioperative care coordination could help reduce prolonged LOSs, lower costs, and, ultimately, give service line management personnel greater flexibility over how to use existing resources as they remain ahead of healthcare reforms.

Journal of Neurosurgery
Source: https://doi.org/10.3171/2020.11.SPINE201403