title: Comparison of perioperative outcomes and cost of spinal fusion for cervical trauma: weekday versus weekend admissions.
abstract: METHODS
  Retrospective database analysis.
  
  
  OBJECTIVE
  To characterize the impact of the admission day (weekday vs. weekend) on the length of stay, costs, complications, and mortality in patients undergoing cervical spine surgery for spinal trauma.
  
  
  BACKGROUND
  The effect of the admission day on the hospital outcomes for patients undergoing anterior cervical fusion (ACF), posterior cervical fusion (PCF), or anterior and posterior cervical fusion (APCF) to manage cervical spine trauma remains unknown.
  
  
  METHODS
  The Nationwide Inpatient Sample was queried from 2002 to 2011. Patients undergoing an ACF, PCF, or APCF for the treatment of cervical spine trauma were identified. Patients were separated into cohorts based on the day of admission (weekday vs. weekend). Patient demographics, comorbidities, admission status, length of stay, costs, mortality, and outcomes were assessed. A value of P ≤ 0.001 denoted statistical significance due to the large sample size.
  
  
  RESULTS
  A total of 34,122 patients underwent cervical fusion for cervical spine trauma between 2002 and 2011. Weekend admits accounted for 11.5% (n = 3126), 19.9% (n = 1048), and 17.2% (n = 301) of the ACF, PCF, and APCF procedures, respectively. On average, the weekend admits in all surgical approaches were younger, had a predilection toward more males, and demonstrated fewer comorbidities than the weekday cohort. ACF-treated weekend admits were hospitalized 4.4 days longer (P = 0.00001) and incurred $10,045 more in total hospital costs than the ACF-treated weekday admits (P = 0.0003). PCF-treated weekend admits were hospitalized 2.6 days longer (P = 0.0003) and incurred $10,227 more in total hospital costs (P = 0.0005). Finally, the APCF-treated weekend admits were hospitalized 4.2 days longer (P = 0.0004) and incurred $11,301 more in total hospital costs (P = 0.0001). The mortality rates were not significantly different among the admission-day cohorts. The ACF-treated weekend cohort demonstrated significantly greater incidences of postoperative infection (P = 0.0003), cardiac complications (P = 0.0004), and urinary tract infection (P = 0.0001) than their weekday admit counterparts.
  
  
  CONCLUSIONS
  The weekend cohorts in all surgical approaches incurred a greater length of stay and total hospital costs than their weekday counterparts. The ACF-treated weekend cohort demonstrated significantly greater incidences of postoperative infection, cardiac complications, and urinary tract infection. There were no significant differences in mortality based on the admission day for any surgical approach. Further research is warranted to further evaluate hospital utilization, costs, and patient outcomes based on the admission day.
authors.affiliation: *Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL; and †Rush Medical College, Chicago, IL.
authors.forename: Sreeharsha V
authors.initials: SV
authors.lastname: Nandyala
authors.forename: Alejandro
authors.initials: A
authors.lastname: Marquez-Lara
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Fineberg
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Schmitt
authors.forename: Kern
authors.initials: K
authors.lastname: Singh
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery*; D005260:Female; D017721:Hospital Costs; D017052:Hospital Mortality; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007297:Inpatients; D007902:Length of Stay / Q000191:economics*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000191:economics; D013997:Time Factors; D016896:Treatment Outcome