title: Predicting Extended Length of Hospital Stay in an Adult Spinal Deformity Surgical Population.
abstract: METHODS
  A retrospective review of a prospective multicenter database.
  
  
  OBJECTIVE
  The aim of this study was to identify variables associated with extended length of stay (ExtLOS) and this impact on health-related quality of life (HRQoL) scores in adult spinal deformity (ASD) patients.
  
  
  BACKGROUND
  ASD surgery is complex and associated with complications including extLOS. Although variables contributing to extLOS have been considered, specific complications and pre-disposing factors among ASD surgical patients remain to be investigated.
  
  
  METHODS
  
  
  
  METHODS
  ASD surgical patients (age >18 years, scoliosis ≥20°, sagittal vertical axis ≥5 cm, pelvic tilt ≥25°, and/or thoracic kyphosis >60°) with complete demographic, radiographic, and HRQoL data at baseline, 6 weeks, and 2 years postoperative. ExtLOS was based on 75th percentile (≥9 days). Univariate and multivariate analyses identified predictors and evaluated effects on outcomes. Repeated-measures mixed models analyzed impact of ExtLOS on HRQoL [Oswestry Disability Index; Short Form-36 physical component summary/mental component summary; SRS22r Activity (AC), Pain (P), Appearance (AP), Satisfaction (S), Mental (M) and Total (T)].
  
  
  RESULTS
  Three hundred eighty patients met inclusion criteria: 105 (27.6%) had extLOS (≥9 days) and 275 (72.4%) did not. Average LOS was 8 days (range: 1-30 days). Age [odds ratio (OR) 1.04], no. of levels fused (OR 1.12), no. of infections (OR 2.29), no. of neurologic complications (OR 2.51), Charlson Comorbidity Index Score (CCI) predicted ExtLOS (OR 3.92), and no. of intraop complications predicted ExtLOS (OR 3.56). ExtLOS patients had more intracardiopulmonary (pleural effusion: 1.9% vs. 0%) and operative complications (dural tear: 13.3% vs. 5.1%; excessive blood loss: 18% vs. 5.8%) (P < 0.022). At 2 years, both groups of patients experienced an overall improvement in all HRQoL scores (P < 0.001). ExtLOS patients had significantly less overall improvement in all HRQoLs (P < 0.01) except for MCS (P = 0.17) and SRS M (P = 0.08).
  
  
  CONCLUSIONS
  Extended LOS of ASD patients is affected by comorbidities (higher CCI) and number of intraoperative, but not peri-operative, complications. All patients improved overall in HRQoL scores, but extended LOS patients improved less overall at 2 years in comparison.
  
  
  METHODS
  3.
authors.affiliation: Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California.
authors.forename: Eric O
authors.initials: EO
authors.lastname: Klineberg
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Passias
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York.
authors.forename: Cyrus M
authors.initials: CM
authors.lastname: Jalai
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York.
authors.forename: Nancy
authors.initials: N
authors.lastname: Worley
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
authors.affiliation: Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas.
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Burton
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Munish C
authors.initials: MC
authors.lastname: Gupta
authors.affiliation: Department of Orthopaedic Surgery, University of Calgary, Calgary, Alberta.
authors.forename: Alex
authors.initials: A
authors.lastname: Soroceanu
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Luke P
authors.initials: LP
authors.lastname: Zebala
authors.affiliation: San Diego Center for Spinal Disorders, La Jolla, California.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Mundis
authors.affiliation: Department of Neurosurgery, Hospital for Special Surgery, New York, New York.
authors.forename: Han Jo
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburg, Pennsylvania.
authors.forename: D Kojo
authors.initials: DK
authors.lastname: Hamilton
authors.affiliation: Department of Orthopaedic Surgery, Oregon Health Sciences University, Portland, Oregon.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Hart
authors.affiliation: Department of Neurosurgery, University of California, San Francisco, California.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Ames
authors.affiliation: Department of Neurosurgery, Hospital for Special Surgery, New York, New York.
authors.forename: Virginie
authors.initials: V
authors.lastname: Lafage
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006760:Hospitalization / Q000639:trends; D006801:Humans; D007738:Kyphosis / Q000175:diagnosis* / Q000601:surgery*; D007902:Length of Stay / Q000639:trends*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012189:Retrospective Studies; D012600:Scoliosis / Q000175:diagnosis* / Q000601:surgery*