title: Factors affecting hospital length of stay following anterior cervical discectomy and fusion.
abstract: METHODS
  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].
authors.affiliation: Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas, USA.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Arnold
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Rice
authors.forename: Karen K
authors.initials: KK
authors.lastname: Anderson
authors.forename: Joan K
authors.initials: JK
authors.lastname: McMahon
authors.forename: Lynne M
authors.initials: LM
authors.lastname: Connelly
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Norvell