Day of Surgery Impacts Outcome: Rehabilitation Utilization on Hospital Length of Stay in Patients Undergoing Elective Meningioma Resection.
OBJECTIVE
Meningiomas account for approximately one third of all brain tumors in the United States. In high-volume medical centers, the average length of stay (LOS) for a patient is 6.8 days compared with 8.8 days in low-volume centers with median total admission charges equaling approximately $55,000. To our knowledge, few studies have evaluated day of surgery and its effect on hospital LOS. Our primary goal was to analyze patient outcome as a direct result of surgical date, as well as to characterize the individual variables that may impact their hospital course, early access to rehabilitation, and long-term functional status.


METHODS
A retrospective database was generated for cranial meningioma patients who underwent elective surgical resection at our institution over a 3-year study period (2011-2014). Inclusion criteria included any patient who underwent elective meningioma resection and was discharged either home or to a rehabilitation facility with at least 6 months of follow-up. Exclusion criteria included any patient who was not discharged after resection (i.e., expired). Each patient's medical record was evaluated for a subset of demographics and clinical variables. Given that patients who undergo surgical resection of meningiomas have a national median LOS of 6 days, we subdivided the patients into 2 cohorts: early discharge (LOS < 3) and late discharge (LOS ≥ 3). Statistical analysis was performed using SPSS 21.0 to assess the significance of the results.


RESULTS
We identified 139 (25 male, 114 female) meningioma patients who underwent surgical resection. Seventy of these patients had surgery during the early week (defined as Monday-Wednesday), and 69 had surgery in the later week (Thursday-Friday). The median age for both early and late groups was 58, and the median diameter of the tumor was 3.1 cm and 3.3 cm, respectively. Overall, 55% of the patients had public insurance and 43% had private insurance, with no significant variation between the early and late groups. The median LOS for the early and late populations was 3 and 4 days, respectively. Physical therapy recommendations for rehabilitation facility were made in 26% of early-week patients and in 42% of late-week patients. Additionally, we found a statistically significant decreased LOS (<3 days) in those patients who underwent surgery during the early week (Monday-Wednesday), as opposed to those who received surgery in the later week (Thursday, Friday) (P = 0.045, Mann-Whitney test).


CONCLUSIONS
Day of surgery may play a significant role in LOS for meningioma patients. Clinicians should remain aware of those factors that may delay optimal patient discharge and early access to rehabilitation facilities. Further studies will need to be performed to assess the social variables that may affect LOS, as well as the financial implications for such extended hospital courses.
Icahn School of Medicine at Mount Sinai, Department of Neurosurgery, New York, New York, USA.
Christopher A
CA
Sarkiss
University of Michigan Medical School, Department of Neurosurgery, Ann Arbor, Michigan, USA.
Joseph A
JA
Papin
Icahn School of Medicine at Mount Sinai, Department of Neurosurgery, New York, New York, USA.
Amy
A
Yao
Icahn School of Medicine at Mount Sinai, Department of Neurosurgery, New York, New York, USA.
James
J
Lee
Icahn School of Medicine at Mount Sinai, Department of Neurosurgery, New York, New York, USA.
Roberta K
RK
Sefcik
Icahn School of Medicine at Mount Sinai, Department of Neurosurgery, New York, New York, USA.
Eric K
EK
Oermann
Icahn School of Medicine at Mount Sinai, Department of Neurosurgery, New York, New York, USA.
Errol L
EL
Gordon
Icahn School of Medicine at Mount Sinai, Department of Neurosurgery, New York, New York, USA.
Kalmon D
KD
Post
Icahn School of Medicine at Mount Sinai, Department of Neurosurgery, New York, New York, USA.
Joshua B
JB
Bederson
Icahn School of Medicine at Mount Sinai, Department of Neurosurgery, New York, New York, USA. Electronic address: raj.shrivastava@mountsinai.org.
Raj K
RK
Shrivastava
D000368:Aged; D001071:Appointments and Schedules; D017558:Elective Surgical Procedures / Q000534:rehabilitation* / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008577:Meningeal Neoplasms / Q000453:epidemiology / Q000628:therapy*; D008579:Meningioma / Q000453:epidemiology / Q000628:therapy*; D008875:Middle Aged; D000066530:Neurological Rehabilitation / Q000706:statistics & numerical data*; D019635:Neurosurgical Procedures / Q000534:rehabilitation / Q000706:statistics & numerical data; D015995:Prevalence; D012189:Retrospective Studies; D016896:Treatment Outcome; D014600:Utilization Review; D014850:Waiting Lists
Early discharge; Length of stay; Meningioma; Rehabilitation; Socioeconomics