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.
METHODS
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.


BACKGROUND
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).


CONCLUSIONS
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.


METHODS
3.
From the Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT.
Bryce A
BA
Basques
Daniel D
DD
Bohl
Nicholas S
NS
Golinvaux
Jordan A
JA
Gruskay
Jonathan N
JN
Grauer
D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002574:Cervical Vertebrae / Q000601:surgery*; D015897:Comorbidity; D015986:Confounding Factors, Epidemiologic; D003237:Connecticut / Q000453:epidemiology; D017586:Diskectomy / Q000706:statistics & numerical data*; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008171:Lung Diseases / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013123:Spinal Fusion / Q000706:statistics & numerical data*